Impact of thrombolytic therapy for myocardial infarction in the Bayamón Public Health Care Sector--1993-1995 experience.
The study was designed to evaluate the compliance of general management guidelines, determine the effectiveness of Thrombolytic therapy (TTX), determine the complications, statistics and the "Door to Needle" time (DTN) in the management of Myocardial Infarction (MI) in the Bayamón public health care sector.


METHODS
Retrospective record review and SPSS statistical calculations were performed.


RESULTS
66 cases (49m, 17f) discharged with MI from January 1993 to June 1995 were included. 27 received TTX. 80% were between 30-69 y/o, while 20% from 70-87 y/o. Past hx and habits; smoker 62%, ETOH 45%. Labs in adm; hypoMG 15%, hypoK 11%. The Q MI = 63%, Non Q = 38%. The sinoatrial and ventricular arrhythmias were seldom seen (7.5% SVT, AIVR 3%). Intra and atrioventricular block (3%). The most frequent cardiac complication was CHF 10% and the non cardiac; BKP 16.5%. The mortality was (6.1%). The mean stay was 9.34 days. Therapy used; IV NTG 97%, ASA 84%, beta B 39%, TTX 42.2%, ACE inhibitors 32%. Absence of TTX was usually due to absence of EKG criteria (63%). TTX complications; hypotension 10.5%. The mean DTN was 1hr 58m,. 91% were discharged home, 23.3% cath, deaths 6%. The ER MD assessment of MI was correct in only 29%.


CONCLUSIONS
The complications of patients with MI in the TTX era are below the ones before TTX. Mortality and morbidity have improved with the use of TTX. The medical therapy guidelines of MI are generally followed in HURRA. Improvement in the DTN is needed. The prolonged DTN and the inconsistency of the admission assessment by the ER personnel establishes the need to develop a training program which would regulate this abnormality.
Rivera Del Rio
J R
JR
Dept. Medicine, San Pablo Medical Center, Bayamón, P.R.
Gomez
M A
MA
Dominguez
M
M
Roman
M
M
Perez
L
L
Mayor
M
M
Valentin
A
A
Hunter Mellado
R
R
D000328:Adult; D000368:Aged; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011647:Puerto Rico / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014505:Urban Population
D005343:Fibrinolytic Agents