Thrombolysis in myocardial infarction in a prospective cohort of 2,515 consecutive patients: older age and longer delays lead to a lower thrombolysis rate.
OBJECTIVE
This prospective study sought to determine the rate of thrombolysis in myocardial infarction and the factors that influenced it in everyday practice.


RESULTS
Data were prospectively collected in all patients admitted in all (48) university, community, and private hospitals in three departments in the Rhĵne-Alpes region in France between September 1, 1993 and January 31, 1995. Data from 2,515 patients were included. Overall, 36% of the patients received thrombolysis. The decrease of the thrombolysis rate with age was very regular. The difference between men and women disappeared almost completely when age was taken into account in a bivariate analysis. Among 19 variables introduced in the logistic regression, only the following ones were significant predictors (odds ratio < 1 means less thrombolysis): age (odds ratio: 0.60 per decade), administrative department, type of hospital (community/tertiary: 0.74; private/tertiary: 0.58), history of myocardial infarction or of angina pectoris (0.67), location of myocardial infarction (Q wave non anterior/Q wave anterior: 0.75; non Q wave/Q wave anterior: 0.18), delay between symptoms onset and first medical intervention (0.06), history of cancer (0.47), and history of psychiatric disorder (0.38).


CONCLUSIONS
In France as in other countries, the rate of thrombolysis is low. In order to increase this rate, we have to find ways to be more "aggressive" in older patients, and to precisely describe the health care pathways in order to shorten delays.
Cheneau
E
E
Hĵpital Cardiovasculaire et Pneumologique Louis Pradel, BP Lyon Montchat, Lyon, France.
De Gevigney
G
G
Ecochard
R
R
Rabilloud
M
M
Riche
B
B
Excoffier
S
S
Cao
D
D
Milon
H
H
Delahaye
F
F
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011446:Prospective Studies; D017678:Sex Distribution; D015912:Thrombolytic Therapy; D013997:Time Factors