Fibrinolytic treatment in suspected acute myocardial infarction--use and risks in clinical practice.
OBJECTIVE
To study the adherence to guidelines concerning fibrinolytic treatment of patients with suspected myocardial infarction and to obtain information on severe events in clinical practice.


METHODS
Prospective reporting of all patients admitted for suspected acute myocardial infarction during 4 months in 1994 from 69 (73.4% of all) Swedish coronary care units.


RESULTS
The study covers 10,652 admissions, representing 9726 patients. The mean percentage treated with fibrinolytic drugs of patients with a positive ECG (ST-elevation and/or bundle branch block), a delay < 12 h and no contraindications was 56%. The interhospital range was 18.1-94.1%. Fibrinolytic drugs were given with a delay time > 24 h in 12.5% of women and 15.7% of men, and 36.1% of patients with verified acute myocardial infarction were given fibrinolytic drugs. Streptokinase was used in 82.7% and alteplase in 15.5% of the patients, respectively (interhospital range 0-53.3%).


CONCLUSIONS
Fibrinolytic therapy seems to be used in a non-rational way at several hospitals. Local quality systems may be a way to assure better care.
Beermann
B
B
Department of Drug Epidemiology, Information and Inspection, Medical Products Agency, Uppsala, Sweden.
von Bahr
C
C
Sundström
A
A
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D013300:Streptokinase / Q000009:adverse effects* / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use
D013300:Streptokinase; D010959:Tissue Plasminogen Activator