[Thrombolytic therapy in acute myocardial infarct--is it being used to the fullest?].
OBJECTIVE
To evaluate the experience with thrombolytic therapy (TT) in the treatment of patients with the discharge diagnosis of acute myocardial infarction (AMI).


METHODS
Retrospective analysis of the clinical records of patients with the discharge diagnosis of AMI, between May 1988 and December 1995.


METHODS
Intensive Cardiac Care Unit (UCIM-Medicina IV) of Santa Maria University Hospital, Lisbon, Portugal.


METHODS
1319 patients, 958 men (73%) and 361 women, mean age 64 +/- 12 years.


RESULTS
Thrombolytic therapy was administered in 391 patients (30%). Female patients received less thrombolytic therapy compared with male (17% vs. 34%; p < 0.001). Anterior wall infarction was more frequent (38%). Patients in Killip class I-II (77%) received more thrombolytic therapy than class III-IV (33% vs. 17%). The utilization rate of thrombolytic therapy increased from 25% in 1988 to 34% in 1995. Two major categories of patients were not treated with thrombolysis: 1) patients presented more than 12 hours after pain onset (38%); 2) patients without ST segment elevation or LBBB on the ECG presented (37%). Overall hospital mortality was 15.6%. The mortality in patients receiving thrombolytic therapy was significantly lower than in those excluded (9.4% vs. 18.2%; p < 0.001).


CONCLUSIONS
Only 30% of patients with AMI receive TT. Of those excluded from this important therapeutic intervention, 75% had no ECG criteria or were outside the standard therapeutic "window". This significant group of patients need new diagnostic and intervention strategies.
Carôla
B
B
Unidade de Cuidados Intensivos e Monitorização/Serviço de Medicina IV, Hospital Universitário de Santa Maria, Lisboa.
Calçada-Correia
L
L
Pedro
P G
PG
Conduto
R
R
Dionísio
I
I
Fiuza
M
M
Dias
E
E
Vaz Carneiro
A
A
Amador
M G
MG
de Pádua
F
F
Lopes
M G
MG
D000368:Aged; D016255:Anistreplase / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011174:Portugal / Q000453:epidemiology; D012189:Retrospective Studies; D013300:Streptokinase / Q000627:therapeutic use*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000706:statistics & numerical data; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D016255:Anistreplase; D013300:Streptokinase; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator
Terapêutica trombolítica no enfarte agudo do miocárdio--estará a ser utilizada em pleno?