Impact of thrombolytic therapy for myocardial infarction in the Bayamón Public Health Care Sector--1993-1995 experience
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J R Rivera Del Rio1, M A Gomez, M Dominguez
1Dept. Medicine, San Pablo Medical Center, Bayamón, P.R.
Insights
Thrombolytic therapy (TTX) improved outcomes for Myocardial Infarction (MI) patients, reducing complications and mortality. However, improvements in "Door to Needle" (DTN) time and emergency assessment accuracy are needed.
Area of Science:
- Cardiology
- Public Health
- Emergency Medicine
Background:
- Myocardial Infarction (MI) management requires adherence to guidelines for optimal patient outcomes.
- Thrombolytic therapy (TTX) is a critical intervention for acute MI.
Purpose of the Study:
- To evaluate adherence to MI management guidelines.
- To assess the effectiveness and complications of TTX.
- To determine "Door to Needle" (DTN) times in the Bayamón public health sector.
Main Methods:
- Retrospective review of 66 Myocardial Infarction (MI) patient records (January 1993 - June 1995).
- Statistical analysis using SPSS to evaluate compliance, effectiveness, complications, and DTN.
Main Results:
- 42.2% of MI patients received TTX; complications included hypotension (10.5%).
- Mean DTN was 1 hour 58 minutes; mortality was 6.1%.
- Emergency physician MI assessment accuracy was only 29%.
Conclusions:
- TTX era demonstrated reduced MI complications and improved mortality compared to pre-TTX.
- Adherence to MI medical therapy guidelines is generally good, but DTN requires improvement.
- Inconsistent emergency assessment necessitates a training program to improve MI diagnosis and management.
Unlabelled:
The study was designed to evaluate the compliance of general management guidelines, determine the effectiveness of Thrombolytic therapy (TTX), determine the complications, statistics and the "Door to Needle" time (DTN) in the management of Myocardial Infarction (MI) in the Bayamón public health care sector.
Methods:
Retrospective record review and SPSS statistical calculations were performed.
Results:
66 cases (49m, 17f) discharged with MI from January 1993 to June 1995 were included. 27 received TTX. 80% were between 30-69 y/o, while 20% from 70-87 y/o. Past hx and habits; smoker 62%, ETOH 45%. Labs in adm; hypoMG 15%, hypoK 11%. The Q MI = 63%, Non Q = 38%. The sinoatrial and ventricular arrhythmias were seldom seen (7.5% SVT, AIVR 3%). Intra and atrioventricular block (3%). The most frequent cardiac complication was CHF 10% and the non cardiac; BKP 16.5%. The mortality was (6.1%). The mean stay was 9.34 days. Therapy used; IV NTG 97%, ASA 84%, beta B 39%, TTX 42.2%, ACE inhibitors 32%. Absence of TTX was usually due to absence of EKG criteria (63%). TTX complications; hypotension 10.5%. The mean DTN was 1hr 58m,. 91% were discharged home, 23.3% cath, deaths 6%. The ER MD assessment of MI was correct in only 29%.
Conclusions:
The complications of patients with MI in the TTX era are below the ones before TTX. Mortality and morbidity have improved with the use of TTX. The medical therapy guidelines of MI are generally followed in HURRA. Improvement in the DTN is needed. The prolonged DTN and the inconsistency of the admission assessment by the ER personnel establishes the need to develop a training program which would regulate this abnormality.