Repeat thrombolysis for acute myocardial infarction.
BACKGROUND
Thrombolysis is still the first line of treatment for acute myocardial infarction in the United Kingdom. In a significant proportion of these patients thrombolytic therapy fails to restore patency of the occluded artery or is followed by early re-infarction. The best management of this group of patients is not clear although repeat doses of thrombolysis are commonly administered especially in the district general hospitals that do not have access to invasive facilities. We performed a retrospective clinical study to determine the outcome of repeat thrombolysis for acute myocardial infarction in patients with failed initial thrombolysis or early re-infarction.


METHODS
Ninety-two patients who received two or more doses of thrombolysis for acute myocardial infarction were compared with 98 contemporary similar patients who received only one dose of thrombolysis. Case notes of all patients were examined for retrospective analysis. Main outcome measures were death, heart failure and need for in-hospital revascularization.


RESULTS
Compared to the group thrombolysed once, in the rethrombolysed group there were significantly more deaths at 30 days (p=0.0016), more heart failure (with lower mean ejection fraction), more cardiac arrests as well as more frequent coronary angiography and percutaneous coronary interventions (PCIs). The incidence of haemorrhage in the two groups did not differ.


CONCLUSIONS
The need for repeat thrombolysis identifies a group of patients with a high risk of early complications. Although repeat thrombolysis is safe, these patients then need close monitoring with a view to early intervention. For such patients admitted to district general hospitals without interventional facilities early referral to a tertiary center should be considered.
Banerjee
P
P
Department of Cardiology, Castle Hill Hospital, Kingston upon Hull HU16 5JQ, UK. pbanerjee@ukonline.co.uk
Clark
A L
AL
Norell
M S
MS
D000208:Acute Disease; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006767:Hospitals, District; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents