CORONARY-CARE FOLLOW-UP-STUDY - ACUTE CARE REQUIRED IMMEDIATELY FOLLOWING THROMBOLYTIC THERAPY

We carried out a prospective survey of the outcome of patients with 's uspected myocardial infarction', in order to determine where they shou ld be nursed. The delay between onset, admission, transfer to the CCU, the sequelae and side-effects of thrombolytic therapy were noted and were documented prospectively. Of 217 admissions to CCU with a history of chest pain and suspected acute myocardial infarction during a four -month period (mean age was 62.8 years range 31 to 86 years) 202 fulfi lled the criteria for suspected myocardial infarction. Streptokinase w as given in 129 and alteplase in one patient. The delay between onset of pain and admission was < 4 h in 73, 4 to 12 h in 30 and > 12 h in 2 3. Elderly patients were just as likely as younger ones to receive thr ombolytic therapy (Chi2=3.6; P=0.6). An eventual diagnosis of acute my ocardial infarction was made in 133 of whom 100 received streptokinase . Dysrhythmia or shock was encountered in one-third of those given str eptokinase and a quarter of the remainder. Reactions to streptokinase were recorded in 32 mainly hypotension or bradycardia alone or in comb ination. Forty-five per cent experienced either cardiac complications or drug reactions or both. During one month there were 57 admissions, 50 of whom arrived by ambulance. The mean delay between call out and a rrival in the A&E department was 55 min. We concluded patients who are given thrombolytic therapy need close supervision and they should be nursed in a CCU or its equivalent.