Cor Vasa 2002, 43(7-8):336-343

Treatment of patients with acute myocardial infarction eligible for thrombolysis

Stanislav Cagáň^1,2,*, Zuzana Moťovská², Oľga Jurkovičová³, Soňa Wimmerová¹, Ivana Besedová^1,2, Tomáš Trnovec¹

¹ Ústav preventívnej a klinickej medicíny

² I. Interná klinika Slovenskej postgraduálnej akadémie medicíny

³ IV. Interná klinika Lekárskej fakulty Univerzity Komenského, Bratislava, Slovenská republika

Aim:
To determine the number of patients with acute myocardial infarction (AMI) whose medical history and EKG allow to establish an early diagnosis of AMI and to analyze data, in AMI patients eligible for thrombolytic therapy (TLT), on TLT rates and hospital delay.

Patients and methods:
The project was undertaken as a prospective multicentric study. Independent audit and data collection were undertaken in a total of 3,123 AMI patients in 66 centers in the period from 16 September 1997 through 15 September 1998.

Results:
Timely diagnosis of AMI (still before detecting the serum markers of myocardial necrosis) could be obtained in 1,736 (55.6%) patients. These are the TLT candidates. By eliminating patients with pre-hospital delay > 12 hours, patients aged 75 years and over, and patients with contraindications to TLT, we defined a 951-member group of patients eligible for TLT (30.5% of the 3,123 patients enrolled into the AUDIT group). TLT was performed in 706 (74.2%) of these (TLT underuse). In addition, it was undertaken in 16.9% of other patients (TLT overuse). The median of pre-hospital delay was 140 minutes. The increase in the length of pre-hospital delay was associated with a decrease in the number of patients receiving TLT. Most patients receiving TLT (85.2%) were those reaching hospital within 1 hours developing problems. The median of hospital delay was 30 minutes; still, TLT was started within 30 minutes of hospital admission in only 61.2% of patients a significantly longer hospital delay was seen in female patients, patients with angina in their history, and in patients admitted to general intensive care units. The longest hospital delay (as long as 70 minutes) was observed in patients suspected to have AMI (even repeat) on admission. In comparable subgroups of patients, TLT was significantly less often undertaken in patients over 64 years of age, in females, patients with recurrent AMI, hypertension, diabetes, and in patients with pulmonary edema and in shock. TLT as least often (in only 33.9% of patients) undertaken in patients with suspected AMI (even recurrent) on admission.

Conclusion:
An analysis of TLT in AMI patients eligible for TLT is a marker of quality of treatment. Definition of patients eligible for TLT markedly limits the number of AMI patients eligible for TLT, to about 30% of the total of patients enrolled into the group. TLT is not performed is as much as a quarter of them.

Keywords: Acute myocardial infarction; Timely diagnosis; Patients eligible for thrombolytic therapy; Underuse and overuse of thrombolytic therapy; Audit; Slovakia

Published: July 1, 2002  Show citation