[Endovenous thrombolysis in acute myocardial infarct. The experience in a community hospital. An analysis of 120 patients].
OBJECTIVE
To demonstrate the experience with thrombolytic therapy in a community hospital without a cardiac catheterization laboratory.


METHODS
One hundred and twenty patients with EKG evidence of acute myocardial infarction with less than 6 hours of pain entered the study. They were retrospectively subdivided into two groups: group 1 (n = 96) received streptokinase and group 2 (n = 24) received rt-PA.


RESULTS
One hundred and twenty patients were analysed. Ninety six (80%) received SK and 24 (20%) received intravenous rt-PA. Infarct side was anterior in 57 cases (47.5%) and inferior and/or lateral in 63 (52.5%). Coronary-angiography performed prior the discharge in reference hospital demonstrated patency of culprit vessel in 69 patients (80%) treated with SK and in 22 (91%) treated with rt-PA. According to clinical and angiographic data 60 patients (50%) were managed with medical treatment, 31 (25.8%) were submitted to angioplasty of the culprit artery and 29 (24.1%) underwent coronary bypass surgery. The complications were intracranial hemorrhage in 2 cases (1.6%), 1 post SK (1.0%) and 1 post rt-PA (4%); both of these patients died; reinfarction occurred in 4 patients and in 3 of them SK infusion was repeated successfully. There were no reinfarction in patients receiving rt-PA; major bleeding requiring blood transfusion occurred in 2 patients (1.6%); 1 patient developed hemothorax post SK and another one treated with rt-PA developed hematoma of left inferior limb. Eleven patients (9.1%) died during the hospital stay; 2 patients died of intracranial hemorrhage, 7 of cardiogenic shock and 2 had sudden death. The mortality rate in patient with anterior wall infarction was 15.7%, whereas it was significantly lower in the remaining patients (3.1%, p < 0.05). Only 4 patients over the age 75 received thrombolysis and 2 of them (50%) died.


CONCLUSIONS
Intravenous thrombolytic therapy was safe and feasible in a community hospital without cardiac catheterization facilities. We observed only 2 fatal complications (1.6%) directly related to drug management (intracranial hemorrhage). The hospital mortality was 9.1%, including patient undergoing angioplasty of surgery following thrombolytic therapy.
Jorge
S do C
Sdo C
Hospital e Maternidade Brasil, Santo André, SP.
D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012008:Recurrence; D013300:Streptokinase / Q000008:administration & dosage* / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
D011994:Recombinant Proteins; D013300:Streptokinase; D010959:Tissue Plasminogen Activator
Trombólise endovenosa no infarto agudo do miocárdio. Experiência em hospital comunitário. Análise de 120 pacientes.