[Results of treatment of acute myocardial infarction with thrombolytic therapy. Experiences in 437 patients in the coronary care unit of the National Institute of Cardiology "Ignacio Chavez"].
OBJECTIVE
To review the results and complications of thrombolysis in patients with acute myocardial infarction (AMI) and its complications.


METHODS
Since june 1989 to august 1994 we studied patients with AMI, who underwent thrombolysis. Clinical characteristics, complications and angiographic results are described.


RESULTS
Of the total population 86.3% patients received Streptokinase (SK) and 13.7% recombinant tissue plasminogen activator (rt-PA). In 20 patients the age was under 40 years, 373 between 40-70 years, and 80 patients over 70 years. 84% were men and 16% women. 72% had smoking habit; 21% diabetes mellitus, 43% hypertension, 54% had previous angina and previous AMI in 22%. The location of AMI was anterior in 234 patients and 239 inferior. In 63% enzyme washout was observed, and rapid electrocardiographic evolution in 81%. Postthrombolisis arrhythmias was observed in 64.7%. Major bleeding in 11.8% and central nervous system hemorrhage in 0.4% only with rt-PA. Postinfarction angina in 22%, and re-infarction in 4%. Cardiac rupture in 1.4%, with shock and death. Mitral insufficiency in 2.1% demonstrated by echocardiogram. Coronary angiography was done in 373 patients (80%), of which 50.7% was made in the first 5 days. The culprit artery was anterior descending in 273 patients and right coronary in 95. Left ventricular dysfunction was seen in 23% in patients with anterior AMI, and 5% with inferior AMI. Cardiogenic shock was seen in 7%. Coronary artery bypass grafting was undertaken in 106 patients and coronary angioplasty in 67. The ten days mortality was 8.8%, principally due to cardiogenic shock, ventricular arrhythmias and ventricular rupture.


CONCLUSIONS
The usefull permeability in the culprit artery was obtained in 40%, who had coronary angiography done 145 hours posthrombolysis. Mortality was under 10% in this study.
Juárez Herrera
U
U
Departamento de Urgencias, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Lasses y Ojeda
L A
LA
López
M C
MC
Chuquiure
E
E
González Pacheco
H
H
Carrillo Calvillo
J
J
Martínez Sánchez
C
C
Lupi Herrera
E
E
D000208:Acute Disease; D000328:Adult; D000368:Aged; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use*; D013300:Streptokinase / Q000627:therapeutic use*; D015912:Thrombolytic Therapy
D011994:Recombinant Proteins; D013300:Streptokinase; D010960:Plasminogen Activators
Resultados del enfermo con infarto agudo del miocardio con terapia trombolítica. Experiencia en 473 enfermos de la unidad coronaria del instituto nacional de cardiología ignacio chávez.