EARLY DEATHS WITH THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION IN CORTICOSTEROID-DEPENDENT RHEUMATOID-ARTHRITIS

Intravenous thrombolytic therapy has become standard treatment for acu te myocardial infarction (AMI). We describe three patients with long-s tanding seropositive rheumatoid arthritis (RA) on chronic corticostero id therapy who experienced very early (1-6 h) mortality after the use of intravenous thrombolytic therapy for the treatment of AMI. All thre e patients likely experienced electromechanical dissociation (EMD). Th eir charts were evaluated in depth, and the literature was reviewed in regard to possible etiopathologic mechanisms. Within 1-6 h of apparen tly successful thrombolytic therapy for AMI, these three patients expe rienced sudden and profound bradycardia and hypotension and could not be resuscitated. The potential occurrence of EMD in all three patients raises the possibility of accelerated myocardial rupture, as EMD is o ne of the clinical hallmarks of this condition. As suggested by the th ree clustered cases, this heretofore undescribed association between s udden unexpected cardiac death and thrombolytic therapy for AMI in pat ients with seropositive, corticosteroid-dependent RA suggests that fur ther study and observation are needed. This deleterious association, i f verified, has important implications for the treatment of AMI in pat ients who have RA and are corticosteroid dependent.