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[Thrombolysis in acute myocardial infarct in everyday clinical practice]
E De Benedetti1, P Urban, S Burgan
1Centre de cardiologie, Hôpitaux universitaires de Genève.
Insights
This study on thrombolysis for acute myocardial infarction found that emergency room treatment is effective with short delays. However, the rate of intracerebral hemorrhage was higher than expected, suggesting potential differences in patient selection for thrombolytic therapy.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Context:
- Acute myocardial infarction (AMI) treatment has evolved significantly.
- Thrombolytic therapy is a cornerstone in managing AMI.
- Optimizing treatment times and understanding complication rates are crucial.
Purpose:
- To evaluate the effectiveness and safety of thrombolysis for AMI in a real-world hospital setting.
- To analyze admission-to-treatment times and their trends.
- To identify predictors of intracerebral hemorrhage and in-hospital mortality.
Summary:
- A prospective study included 627 patients with AMI treated with thrombolysis (92% received t-PA) between 1986-1995.
- Median admission-to-treatment time decreased significantly over the study period (55 min to 35 min).
- Intracerebral hemorrhage rate was 2.4%, in-hospital mortality was 8.8%, and negative prognostic factors included older age, advanced Killip class, and elevated peak CPK.
Impact:
- Confirms feasibility of rapid emergency room thrombolysis for AMI.
- Highlights a higher intracerebral hemorrhage rate possibly due to distinct patient selection criteria compared to large trials.
- Provides insights into prognostic factors for AMI patients receiving thrombolytic therapy.
Abstract:
We prospectively included in a database all thrombolyzed acute transmural myocardial infarction patients admitted to our hospital from November 1986 to September 1995. Six hundred and twenty-seven patients (497 males) with a mean age of 61 +/- 12 years (range 26-88 years) were included. 87% were having their first acute myocardial infarction. Different thrombolytic regimens were applied in the emergency room but the vast majority (92%) received t-PA. The median delay between the onset of pain and admission was 2 h 0 min (10 min-22 h). The median admission to treatment time was 40 min (5 min-6 h 20 min). The latter has been shortened (median 55 min from 1986 to 1989 versus 35 min from 1990 to 1995, p < 0.05) during the study period. The rate of intracerebral hemorrhage was 2.4% (confidence interval 1.1-3.5%) and no significant predictor could be found, although patients with cerebral bleeding tended to be slightly older (66 +/- 9 years vs 61 +/- 13 years, p = ns). The rate of false diagnosis was only 4.6%, even when patients with a final diagnosis of unstable angina and/or aborted acute myocardial infarction were included. The in-hospital mortality was 8.8%, a rate similar to those reported in the literature. Using multivariate analysis, negative prognostic factors were higher age (p < 0.001), advanced Killip class at admission (p < 0.001) and elevated peak CPK levels (p < 0.001). These results confirm that thrombolysis for acute myocardial infarction in the emergency room can be done with a short admission-to-treatment time and with an acceptably low rate of false diagnosis. However, our intracerebral hemorrhage rate was clearly higher than generally reported in the literature and may be explained by a different patient selection from that in large randomized studies.