INTERNATIONAL TRIALS AND NATIONAL PRACTICE - A QUESTIONNAIRE SURVEY OF CURRENT PHYSICIAN PRACTICE IN THE TREATMENT OF ACUTE MYOCARDIAL-INFARCTION

To establish current national clinical practice in the care of patient s with acute myocardial infarction (AMI), a questionnaire survey of 50 consultant physicians currently working in the Republic of Ireland wa s carried out, There were 45 (90%) respondants, 32/45 (71%) give throm bolysis in CCU only; 13/45 (29%) give thrombolysis in casualty also, S treptokinase (Stk) is the first choice thrombolytic agent for the majo rity, 14/45 (31%) use tPA for anterior AMI in patients under 60 years, Angiotensin converting enzyme (ACE) inhibitors are given by 34/45 (76 %) to patients with evidence of left ventricular dysfunction, ACE inhi bitors are neither used routinely nor are they prescribed in the first three days after the AMI by the majority of the physicians surveyed, Serum magnesium is checked routinely by 5/45 (11%) and intravenous mag nesium is given routinely by 5/45 (11%), The percentage of AMI patient s considered for angiography varied from 10-50%. Despite reports from randomised, controlled trials showing reduced mortality in patients gi ven tPA (versus Stk), routine early ACE inhibition and intravenous mag nesium post-AMI, most clinicians in Ireland use streptokinase, selecti ve late ACE inhibition and no magnesium, The reasons for the dichotomy between the favourable results of randomised clinical trials and rout ine practice are speculative.