THROMBOLYSIS IN ACUTE MYOCARDIAL-INFARCTI ON IN EVERYDAY CLINICAL-PRACTICE

We prospectively included in a database all thrombolyzed acute transmu ral myocardial infarction patients admitted to our hospital from Novem ber 1986 to September 1995. Six hundred and twenty-seven patients (497 males) with a mean age of 61+/-12 years (range 26-88 years) were incl uded. 87% were having their first acute myocardial infarction. Differe nt thrombolytic regimens were applied in the emergency room but the va st majority (92%) received t-PA. The median delay between the onset of pain and admission was 2 h 0 min (10 min-22 h). The median admission to treatment time was 40 min (5 min-6h 20 min). The latter has been sh ortened (median 55 min from 1986 to 1989 versus 35 min from 1990 to 19 95, p<0.05) during the study period. The rate of intracerebral hemorrh age was 2.4% (confidence interval 1.1-3.5%) and no significant predict or could be found, although patients with cerebral bleeding tended to be slightly older (66+/-9 years vs 61+/-13 years, p=ns). The rate of f alse diagnosis was only 4.6%, even when patients with a final diagnosi s of unstable angina and/or aborted acute myocardial infarction were i ncluded. The in-hospital mortality was 8.8%, a rate similar to those r eported in the literature. Using multivariate analysis, negative progn ostic factors were higher age (p<0.001), advanced Killip class at admi ssion (p<0.001) and elevated peak CPK levels (p<0.001). These results confirm that thrombolysis for acute myocardial infarction in the emerg ency room can be done with a short admission-to-treatment time and wit h an acceptably low rate of false diagnosis. However, our intracerebra l hemorrhage rate was clearly higher than generally reported in the li terature and may be explained by a different patient selection from th at in large randomized studies.