A. Reikvam et D. Ketley, THROMBOLYTIC ELIGIBILITY IN ACUTE MYOCARDIAL-INFARCTION PATIENTS ADMITTED TO NORWEGIAN HOSPITALS, International journal of cardiology, 61(1), 1997, pp. 79-83
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.