Prospective evaluation of eligibility for thrombolytic therapy in acute myocardial infarction.
OBJECTIVE
To determine the proportion of patients presenting with acute myocardial infarction who are eligible for thrombolytic therapy.


METHODS
Cohort follow up study.


METHODS
The four coronary care units in Auckland, New Zealand.


METHODS
All 3014 patients presenting to the units with suspected myocardial infarction in 1993.


METHODS
Eligibility for reperfusion with thrombolytic therapy (presentation within 12 hours of the onset of ischaemic chest pain with ST elevation > or = 2 mm in leads V1-V3, ST elevation > or = 1 mm in any other two contiguous leads, or new left bundle branch block); proportions of (a) patients eligible for reperfusion and (b) patients with contraindications to thrombolysis; death (including causes); definite myocardial infarction.


RESULTS
948 patients had definite myocardial infarction, 124 probable myocardial infarction, and nine ST elevation but no infarction; 1274 patients had unstable angina and 659 chest pain of other causes. Of patients with definite or probable myocardial infarction, 576 (53.3%) were eligible for reperfusion, 39 had definite contraindications to thrombolysis (risk of bleeding). Hence 49.7% of patients (537/1081) were eligible for thrombolysis and 43.5% (470) received this treatment. Hospital mortality among patients eligible for reperfusion was 11.7% (55/470 cases) among those who received thrombolysis and 17.0% (18/106) among those who did not.


CONCLUSIONS
On current criteria about half of patients admitted to coronary care units with definite or probable myocardial infarction are eligible for thrombolytic therapy. Few eligible patients have definite contraindications to thrombolytic therapy. Mortality for all community admissions for myocardial infarction remains high.
French
J K
JK
Coronary Care Unit, Green Lane Hospital, Auckland, New Zealand.
Williams
B F
BF
Hart
H H
HH
Wyatt
S
S
Poole
J E
JE
Ingram
C
C
Ellis
C J
CJ
Williams
M G
MG
White
H D
HD
D000367:Age Factors; D000368:Aged; D000075202:Contraindications; D003325:Coronary Care Units; D004562:Electrocardiography; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D009520:New Zealand; D018579:Patient Selection; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*