Thrombolytic therapy in acute myocardial infarction: Experience at a university hospital in Kuwait

Background: There is conclusive evidence from large clinical trials that th rombolytic therapy reduces mortality and morbidity in acute myocardial infa rction (AMT). However, only a small proportion of patients receive thrombol ytic treatment. Estimates have varied from 20%-50% in North America and Eur ope. Data from the Arab Middle East is sparse. The purpose of our study was to determine the use of thrombolytic therapy in our hospital. Methods: We conducted a retrospective analysis of 343 patients (358 inciden ts of AMP), who were either discharged from or died at the coronary care un it of the Mubarak Al-Kabeer Hospital during the one-year period between Jun e 1994 and May 1995. Results: Our patients were relatively younger (63% were <55 years) and had a much higher prevalence (44%) of diabetes compared to European patients. W e observed a high rate (62%) of thrombolysis and a lesser shortfall (8%) wh en compared to that reported for European patients. The main reason for wit hholding thrombolytic therapy was non-diagnostic electrocardiogram (ECG) on initial presentation. Women were less likely to be thrombolyzed than men ( 38% vs. 66%, P=0.0001). Older patients (aged >65 years) were also less like ly to be thrombolyzed than younger patients (42% vs. 66%: P=0.0006). Conclusion: We conclude that the use of thrombolytic therapy in this univer sity hospital in Kuwait is appropriate. However, as observed in other repor ts as well, the underutilization of thrombolytic therapy in women and the e lderly needs to be addressed in future studies.