THROMBOLYTIC ELIGIBILITY IN ACUTE MYOCARDIAL-INFARCTION PATIENTS ADMITTED TO NORWEGIAN HOSPITALS

We characterised the population of acute myocardial infarction patient s admitted to Norwegian hospitals and quantified the actual use and po tential maximal use of thrombolytic therapy. Data were collected by me dical record review of all acute myocardial infarction patients discha rged from hospital in April and May 1993 in Health region 1. The clini cal population differed significantly from the patients recruited to t he thrombolytic clinical trials. Patients were more likely to have ST depression on admission (23% vs. 7%) and to be over 74 years (42% vs. 10%) than in the trials. A fifth of patients presented more than 12 h after symptom onset (or time indeterminate). Thrombolysis was given to 32% of patients, mainly utilising streptokinase. Late presentation or diagnostic difficulty appeared to be the main reasons for non-thrombo lysis. Approximately 50% of the clinical population were eligible for thrombolysis. Eligibility for thrombolytic therapy was therefore sever ely restricted by the presenting characteristics of the clinical popul ation. Substantial numbers of patients belonged to subgroups where the reported benefit from thrombolysis is equivocal. Uncertainty remains on the extrapolation of the trials evidence to those subgroups who wer e under-represented in the clinical trials. (C) 1997 Elsevier Science Ireland Ltd.