ADMINISTRATION OF THROMBOLYTIC THERAPY TO 17,944 PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION - THE GISSI-3 DATABASE

Background There is growing interest in assessing therapy for acute my ocardial infarction. Because thrombolysis was not a study therapy in t he GISSI-3 trial, the decision about thrombolysis was left to the resp onsible physicians. We evaluated the data on thrombolytic therapy amon g patients with acute myocardial infarction enrolled in the GISSI-3 tr ial to study the relation between rate of prescription and the charact eristics of patients and participating coronary care units. Methods Co mplete clinical data were available for 17,944 patients randomized bet ween June 1991 and July 1993 from 200 coronary care units in Italy. De mographic and clinical information were obtained for each patient, and each coronary care unit was classified according to patient volume, l evel of technology, and wide geographic area in which it was located. A multivariate logistic regression was performed with administration o f thrombolytic therapy as the dependent variable and previously define d clinical and structural variables as independent variables. Results The most important factor in administration of thrombolytic therapy wa s that less than 6 hours elapse from symptom onset to hospital admissi on (odds ratio [OR] 14.05; 95% confidence interval [Cl] 12.3 to 16.0). Next were location of coronary care unit in southern Italy (OR 1.81; 95% Cl 1.62 to 2.01), presence of ST elevation at entrance electrocard iogram ECG (OR 1.47; 95% Cl 1.35 to 1.61), absence of previous myocard ial infarction (OR 1.35; 95% Cl 1.22 to 1.49), and presence of cathete rization laboratory or cardiac surgery program or both in the same hos pital (OR 1.24; 95% Cl 1.14 to 1.35). Coronary care units with high or low patient volume did not show different rates of administration of thrombolytic agents. Conclusions The GISSI-3 experience confirmed a hi gh rate of prescription of thrombolytic therapy to patients admitted w ithin 6 hours of symptom onset and those with ST-segment elevation on entrance electrocardiogram. It demonstrated that patients admitted to coronary care units with catheterization laboratories or cardiac progr ams or both have higher chances of receiving thrombolytic treatment th an those admitted to hospitals without these capabilities.