The outcome of patients with acute myocardial infarction ineligible for thrombolytic therapy. Israeli Thrombolytic Survey Group.
OBJECTIVE
The aim of this study was to determine the proportion of patients with acute myocardial infarction (AMI) excluded from thrombolytic therapy on a national basis and to evaluate the prognosis of these patients by reasons of ineligibility and according to the alternative therapies that they received during hospitalization.


METHODS
During a national survey, 1,014 consecutive patients with AMI were hospitalized in all the 25 coronary care units operating in Israel.


RESULTS
Three hundred and eighty-three patients (38%) were treated with a thrombolytic agent and included in the GUSTO study. Ineligible patients for GUSTO were treated: (1) without any reperfusion therapy (n = 449), (2) by mechanical revascularization (n = 97), or (3) given 1.5 million units of streptokinase (n = 85) outside of the GUSTO protocol. The inhospital and 1-year post-discharge mortality rates were 6% and 2% in patients included in the GUSTO study; 6% and 5% in those mechanically reperfused; 15% and 10% in those treated with thromoblysis despite ineligibility for the GUSTO trial, and 15% and 13% among patients not treated with any reperfusion therapy.


CONCLUSIONS
Ineligibility for thrombolysis among patients with AMI remains high. Patients ineligible for thrombolysis according to the GUSTO criteria, but nevertheless treated with a thrombolytic agent were exposed to an increased risk.
Behar
S
S
Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel.
Gottlieb
S
S
Hod
H
H
Benari
B
B
Narinsky
R
R
Pauzner
H
H
Rechavia
E
E
Faibel
H E
HE
Katz
A
A
Roth
A
A
Goldhammer
E
E
Freedberg
N A
NA
Rougin
N
N
Kracoff
O
O
Shapira
C
C
Jafari
J
J
Lotan
C
C
Daka
F
F
Weiss
T
T
Kanetti
M
M
Klutstein
M
M
Rudnik
L
L
Barasch
E
E
Mahul
N
N
Blondheim
D
D
D000206:Actuarial Analysis; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization; D011379:Prognosis; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D005343:Fibrinolytic Agents