Impact of thrombolytic therapy on short and long-term survival of a cohortof patients with acute myocardial infarction consecutively admitted to allthe hospitals of a health care area. GESIR-5 study

Aim. This study aims to assess the application of thrombolysis in patients with acute myocardial infarction admitted to all the hospitals of a health care area in Catalonia (Spain), and to estimate the effect of thrombolysis on short and long-term survival. Methods. From May 1992 to May 1993, all the patients with myocardial infarc tion admitted to the hospitals of the Costa de Ponent area in the first 72 hours after the initial symptoms were consecutively included in this prospe ctive study. Information on pre-hospital phase, emergency room management a nd hospitalization was collected. All the patients discharged alive from ho spital were followed up by telephone one and four years after hospital admi ssion. Results. 521 patients aged 74 years or less were included. Thrombolytic the rapy was applied,in 35.3%. There were no statistically significant differen ces in the proportion of thrombolysis between hospitals with or without int ensive care or coronary units. Ten patients died in the emergency room; in the remaining cases, the 28-day case fatality was 10.0%.. The effect of thr ombolytic treatment on 28-day case fatality was estimated in a logistic reg ression model, after controlling for age, gender, Killip, ventricular arrhy thmia and location of infarction (OR: 0.36; CI 95%. 0.15-0.88). In 28-day s urvivors, the 4-year cumulated probability of survival was 88.4%, being sig nificantly higher in the group who had received thrombolytic therapy. Conclusions, In the population studied, 28-day case mortality of acute myoc ardial infarction is similar to that reported in other Mediterranean region s. The benefits of thrombolysis in the acute phase are found to persist aft er 4 years.