[Impact of thrombolytic therapy on short and long-term survival of a cohort of patients with acute myocardial infarction consecutively admitted to all the hospitals of a health care area. GESIR-5 study].
OBJECTIVE
This study aims to assess the application of thrombolysis in patients with acute myocardial infarction admitted to all the hospitals of a health care area in Catalonia (Spain), and to estimate the effect of thrombolysis on short and long-term survival.


METHODS
From May 1992 to May 1993, all the patients with myocardial infarction admitted to the hospitals of the Costa de Ponent area in the first 72 hours after the initial symptoms were consecutively included in this prospective study. Information on pre-hospital phase, emergency room management and hospitalization was collected. All the patients discharged alive from hospital were followed up by telephone one and four years after hospital admission.


RESULTS
521 patients aged 74 years or less were included. Thrombolytic therapy was applied in 35.3%. There were no statistically significant differences in the proportion of thrombolysis between hospitals with or without intensive care or coronary units. Ten patients died in the emergency room; in the remaining cases, the 28-day case fatality was 10.0%. The effect of thrombolytic treatment on 28-day case fatality was estimated in a logistic regression model, after controlling for age, gender, Killip, ventricular arrhythmia and location of infarction (OR: 0.36; CI 95%: 0.15-0.88). In 28-day survivors, the 4-year cumulated probability of survival was 88.4%, being significantly higher in the group who had received thrombolytic therapy.


CONCLUSIONS
In the population studied, 28-day case mortality of acute myocardial infarction is similar to that reported in other Mediterranean regions. The benefits of thrombolysis in the acute phase are found to persist after 4 years.
Peraire
M
M
Hospital Sant Camil, Ctra. Puigmolto, s/n 08810 Sant Pere de Ribes, Barcelona, Spain. med012359@nacom.es
Martín-Baranera
M
M
Pallarés
C
C
D000328:Adult; D000368:Aged; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D015912:Thrombolytic Therapy; D013997:Time Factors