THE OUTCOME OF PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION INELIGIBLE FOR THROMBOLYTIC THERAPY

PURPOSE: The aim of this study was to determine the proportion of pati ents with acute myocardial infarction (AMI) excluded from thrombolytic therapy on a national basis and to evaluate the prognosis of these pa tients by reasons of ineligibility and according to the alternative th erapies that they received during hospitalization. PATIENTS AND METHOD S: During a national survey, 1,014 consecutive patients with AMI were hospitalized in all the 25 coronary care units operating in Israel.RES ULTS: Three hundred and eighty-three patients (38%) were treated with a thrombolytic agent and included in the GUSTO study. Ineligible patie nts for GUSTO were treated: (1) without any reperfusion therapy (n = 4 49), (2) by mechanical revascularization (n = 97), or (3) given 1.5 mi llion units of streptokinase (n = 85) outside of the GUSTO protocol. T he in-hospital and 1-year post-discharge mortality rates were 6% and 2 % in patients included in the GUSTO study; 6% and 5% in those mechanic ally reperfused; 15% and 10% in those treated with thromoblysis despit e ineligibility for the GUSTO trial, and 15% and 13% among patients no t treated with any reperfusion therapy. CONCLUSIONS: Ineligibility for thrombolysis among patients with AMI remains high. Patients ineligibl e for thrombolysis according to the GUSTO criteria, but nevertheless t reated with a thrombolytic agent were exposed to an increased risk.