Acute myocardial infarction: are there missed opportunities for reperfusion?

Aims To investigate the current use of thrombolytic therapy in the manageme nt of patients with acute myocardial infarction and to determine the potent ial for an increased use of thrombolysis or percutaneous transluminal coron ary angioplasty (PTCA). Methods and results All hospitalised cases of acute myocardial infarction w ere identified in three health districts in the UK (population of 960 000) in patients under the age of 76 years during a 2-year period; 2439 patients had acute myocardial infarction, of whom 1264 (52%) received thrombolytic therapy. Failure to administer thrombolytic therapy was a result of the abs ence of diagnostic electrocardiograms in 712 (29.2%) patients, late present ation in 127 (5.2%), therapeutic error in 112 (4.6%), presence of a bleedin g risk in 139 (5.7%) and other miscellaneous reasons in 80 (3.3%) patients. Thirty-eight of the 139 patients in whom bleeding risk was reported as a c ontra-indication could, in retrospect, have received thrombolytic therapy a nd a further 76 would have been suitable for primary PTCA. Conclusions The potential for increasing the use of thrombolytic therapy se ems to be limited and is unlikely to make a major impact on the in-hospital mortality from acute myocardial infarction. However, primary PTCA should b e considered in those who are ineligible for thrombolysis because of bleedi ng risk as a contraindication. Coronary Artery Dis 9:753-758 (C) 1998 Lippi ncott Williams & Wilkins.