IMPACT OF EARLY REPERFUSION THERAPY ON TH E COURSE OF ACUTE MYOCARDIAL-INFARCTION DURING HOSPITALIZATION

Reperfusion therapy has contributed to decreased morbidity and mortali ty in patients with acute myocardial infarction (AMI). Implementation of thrombolytic therapy, primary angioplasty and emergency coronary ar tery by-pass surgery have proved to be effective in well designed cont rolled clinical trials. There is little information, however, about th e impact of reperfusion therapy in the general clinical population tha t is usually seen in the coronary care unit. In this paper we have com pared the clinical course, morbidity and mortality of patients attende d for a first AMI in 2 different periods. Group I comprised 431 patien ts seen during the period 1981-1986 and group II had 113 patients seen during 1992-1993. Age, gender distribution and AMI location were simi lar in both groups. Patients in group I had a significantly higher inc idence of tobacco use and previous angina pectoris. In group I, 4% of patients received streptokinase, 0.9% of patients had emergency by-pas s surgery and none had primary angioplasty, whereas in group II, 29% o f patients received trombolytics, 6.5% had primary angioplasty and 6.5 % had primary angioplasty and 6.5% had by-pass surgery. Heart failure Killip class II-III occurred in 35% of patients in group I and in 13% of patients in group II (p<0.05). Intrahospital mortality was 19.6% in group I and 11.5% in Group II (p<0.045). Ther were no differences in the incidence of cardiogenic shock in both groups. Multivariate analys is showed that age and heart failure were significant independent pred ictors of mortality in both periods. Thus, there has been a significan t change in the therapeutic approach to AMI patients in recent years. Widespread utilization of reperfusion therapy appears to be associated with decrease in morbidity and mortality in a general population of p atients with a first AMI.