Thrombolytic therapy in acute myocardial infarction: practice pattern at an Arab Middle Eastern centre

Objectives - We studied the use of thrombolytic treatment at a major hospit al in Kuwait. There were three aims to our study. First, to document the ra tes of use and shortfall of thrombolytic therapy. Secondly, to identify the reasons for the shortfall,Thirdly, to study the influence of age and gende r on the shortfall. Methods and results - We retrospectively examined the use of thrombolytic t reatment in 983 consecutive patients with the diagnosis of acute myocardial infarction (AMI) during a three-year period, from lune 1994 to May 1997. T he term "shortfall" refers to the number of patients who were eligible for thrombolytic treatment but did not receive it. Patients were relatively you ng (59% were < 55 years old),There was a high prevalence of diabetes (39%). We identified 669 patients who were eligible to receive thrombolytic thera py (68% of the total AMI population). Of the eligible population, 625 patie nts (93.4%) received thrombolytic therapy while 44 patients did not (a shor tfall of 6.6% among the eligible population). The reasons for the shortfall were: unknown reasons, retinopathy, and others. The shortfall was higher i n women than in men (13% vs. 6%, respectively; p=0.02),The shortfall was hi gher in older patients than in younger patients (18% vs. 5%, respectively; p=0.0002), Conclusions - Our thrombolysis rate is one of the highest, and the shortfal l is one of the lowest reported rates in the literature, Many eligible wome n and older patients are not receiving thrombolytic therapy. Changes to thr ombolytic therapy use should be implemented to avoid unnecessary shortfall and potential gender and age bias.