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. 1996 Jun 29;312(7047):1637–1641. doi: 10.1136/bmj.312.7047.1637

Prospective evaluation of eligibility for thrombolytic therapy in acute myocardial infarction.

J K French 1, B F Williams 1, H H Hart 1, S Wyatt 1, J E Poole 1, C Ingram 1, C J Ellis 1, M G Williams 1, H D White 1
PMCID: PMC2351378  PMID: 8664716

Abstract

OBJECTIVES--To determine the proportion of patients presenting with acute myocardial infarction who are eligible for thrombolytic therapy. DESIGN--Cohort follow up study. SETTING--The four coronary care units in Auckland, New Zealand. SUBJECTS--All 3014 patients presenting to the units with suspected myocardial infarction in 1993. MAIN OUTCOME MEASURES--Eligibility for reperfusion with thrombolytic therapy (presentation within 12 hours of the onset of ischaemic chest pain with ST elevation > or = 2 mm in leads V1-V3, ST elevation > or = 1 mm in any other two contiguous leads, or new left bundle branch block); proportions of (a) patients eligible for reperfusion and (b) patients with contraindications to thrombolysis; death (including causes); definite myocardial infarction. RESULTS--948 patients had definite myocardial infarction, 124 probable myocardial infarction, and nine ST elevation but no infarction; 1274 patients had unstable angina and 659 chest pain of other causes. Of patients with definite or probable myocardial infarction, 576 (53.3%) were eligible for reperfusion, 39 had definite contraindications to thrombolysis (risk of bleeding). Hence 49.7% of patients (537/1081) were eligible for thrombolysis and 43.5% (470) received this treatment. Hospital mortality among patients eligible for reperfusion was 11.7% (55/470 cases) among those who received thrombolysis and 17.0% (18/106) among those who did not. CONCLUSIONS--On current criteria about half of patients admitted to coronary care units with definite or probable myocardial infarction are eligible for thrombolytic therapy. Few eligible patients have definite contraindications to thrombolytic therapy. Mortality for all community admissions for myocardial infarction remains high.

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Selected References

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  1. Barbash G. I., White H. D., Modan M., Van de Werf F. Significance of diabetes mellitus in patients with acute myocardial infarction receiving thrombolytic therapy. Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. J Am Coll Cardiol. 1993 Sep;22(3):707–713. doi: 10.1016/0735-1097(93)90180-9. [DOI] [PubMed] [Google Scholar]
  2. Behar S., Abinader E., Caspi A., David D., Flich M., Friedman Y., Hod H., Kaplinsky E., Kishon Y., Kristal N. Frequency of use of thrombolytic therapy in acute myocardial infarction in Israel. Am J Cardiol. 1991 Nov 15;68(13):1291–1294. doi: 10.1016/0002-9149(91)90233-b. [DOI] [PubMed] [Google Scholar]
  3. Cragg D. R., Friedman H. Z., Bonema J. D., Jaiyesimi I. A., Ramos R. G., Timmis G. C., O'Neill W. W., Schreiber T. L. Outcome of patients with acute myocardial infarction who are ineligible for thrombolytic therapy. Ann Intern Med. 1991 Aug 1;115(3):173–177. doi: 10.7326/0003-4819-115-3-173. [DOI] [PubMed] [Google Scholar]
  4. Haines A., Jones R. Implementing findings of research. BMJ. 1994 Jun 4;308(6942):1488–1492. doi: 10.1136/bmj.308.6942.1488. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Karnash S. L., Granger C. B., White H. D., Woodlief L. H., Topol E. J., Califf R. M. Treating menstruating women with thrombolytic therapy: insights from the global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries (GUSTO-I) trial. J Am Coll Cardiol. 1995 Dec;26(7):1651–1656. doi: 10.1016/0735-1097(95)00386-x. [DOI] [PubMed] [Google Scholar]
  6. Kennedy J. W., Ritchie J. L., Davis K. B., Stadius M. L., Maynard C., Fritz J. K. The western Washington randomized trial of intracoronary streptokinase in acute myocardial infarction. A 12-month follow-up report. N Engl J Med. 1985 Apr 25;312(17):1073–1078. doi: 10.1056/NEJM198504253121701. [DOI] [PubMed] [Google Scholar]
  7. Ketley D., Woods K. L. Impact of clinical trials on clinical practice: example of thrombolysis for acute myocardial infarction. Lancet. 1993 Oct 9;342(8876):891–894. doi: 10.1016/0140-6736(93)91945-i. [DOI] [PubMed] [Google Scholar]
  8. Muller D. W., Topol E. J. Selection of patients with acute myocardial infarction for thrombolytic therapy. Ann Intern Med. 1990 Dec 15;113(12):949–960. doi: 10.7326/0003-4819-113-12-949. [DOI] [PubMed] [Google Scholar]
  9. Neches R. B., Goldfarb A. M., Saviano G. J. Thrombolytic therapy in acute myocardial infarction following prolonged cardiopulmonary resuscitation. Clin Cardiol. 1991 Jul;14(7):616–619. doi: 10.1002/clc.4960140715. [DOI] [PubMed] [Google Scholar]
  10. Rogers W. J., Bowlby L. J., Chandra N. C., French W. J., Gore J. M., Lambrew C. T., Rubison R. M., Tiefenbrunn A. J., Weaver W. D. Treatment of myocardial infarction in the United States (1990 to 1993). Observations from the National Registry of Myocardial Infarction. Circulation. 1994 Oct;90(4):2103–2114. doi: 10.1161/01.cir.90.4.2103. [DOI] [PubMed] [Google Scholar]
  11. Rossi P., Bolognese L. Comparison of intravenous urokinase plus heparin versus heparin alone in acute myocardial infarction. Urochinasi per via Sistemica nell'Infarto Miocardico (USIM) Collaborative Group. Am J Cardiol. 1991 Sep 1;68(6):585–592. doi: 10.1016/0002-9149(91)90348-o. [DOI] [PubMed] [Google Scholar]
  12. Scholz K. H., Tebbe U., Herrmann C., Wojcik J., Lingen R., Chemnitius J. M., Brune S., Kreuzer H. Frequency of complications of cardiopulmonary resuscitation after thrombolysis during acute myocardial infarction. Am J Cardiol. 1992 Mar 15;69(8):724–728. doi: 10.1016/0002-9149(92)90494-j. [DOI] [PubMed] [Google Scholar]
  13. Simoons M. L., Serruys P. W., vd Brand M., Bär F., de Zwaan C., Res J., Verheugt F. W., Krauss X. H., Remme W. J., Vermeer F. Improved survival after early thrombolysis in acute myocardial infarction. A randomised trial by the Interuniversity Cardiology Institute in The Netherlands. Lancet. 1985 Sep 14;2(8455):578–582. doi: 10.1016/s0140-6736(85)90584-7. [DOI] [PubMed] [Google Scholar]
  14. Tenaglia A. N., Califf R. M., Candela R. J., Kereiakes D. J., Berrios E., Young S. Y., Stack R. S., Topol E. J. Thrombolytic therapy in patients requiring cardiopulmonary resuscitation. Am J Cardiol. 1991 Oct 15;68(10):1015–1019. doi: 10.1016/0002-9149(91)90488-7. [DOI] [PubMed] [Google Scholar]
  15. Thompson J. T., de Bustros S., Michels R. G., Rice T. A. Results and prognostic factors in vitrectomy for diabetic vitreous hemorrhage. Arch Ophthalmol. 1987 Feb;105(2):191–195. doi: 10.1001/archopht.1987.01060020045025. [DOI] [PubMed] [Google Scholar]
  16. Ward H., Yudkin J. S. Thrombolysis in patients with diabetes. BMJ. 1995 Jan 7;310(6971):3–4. doi: 10.1136/bmj.310.6971.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. White H. D., Norris R. M., Brown M. A., Takayama M., Maslowski A., Bass N. M., Ormiston J. A., Whitlock T. Effect of intravenous streptokinase on left ventricular function and early survival after acute myocardial infarction. N Engl J Med. 1987 Oct 1;317(14):850–855. doi: 10.1056/NEJM198710013171402. [DOI] [PubMed] [Google Scholar]
  18. White H. D., Rivers J. T., Maslowski A. H., Ormiston J. A., Takayama M., Hart H. H., Sharpe D. N., Whitlock R. M., Norris R. M. Effect of intravenous streptokinase as compared with that of tissue plasminogen activator on left ventricular function after first myocardial infarction. N Engl J Med. 1989 Mar 30;320(13):817–821. doi: 10.1056/NEJM198903303201301. [DOI] [PubMed] [Google Scholar]
  19. Wilcox R. G., von der Lippe G., Olsson C. G., Jensen G., Skene A. M., Hampton J. R. Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction. Anglo-Scandinavian Study of Early Thrombolysis (ASSET). Lancet. 1988 Sep 3;2(8610):525–530. doi: 10.1016/s0140-6736(88)92656-6. [DOI] [PubMed] [Google Scholar]
  20. Woods K. L., Ketley D. Thrombolysis and acute myocardial infarction. Lancet. 1994 Jan 22;343(8891):232–233. doi: 10.1016/s0140-6736(94)91016-2. [DOI] [PubMed] [Google Scholar]

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