Eligibility of patients with acute myocardial infarction for thrombolytic therapy: retrospective cohort study.

AIM To investigate the eligibility of patients with acute myocardial infarction (AMI) for thrombolytic therapy (TT) and evaluate the results of treatment. METHODS Retrospective analysis included 366 patients with AMI, mean age 66+/-11 years, treated in 1999. We analyzed age, gender, previous infarction, previous TT, present TT with streptokinase and its effects on the course and outcome, pain-to-door time, and door-to-needle time. Reperfusion and reocclusion were evaluated non-invasively according to the occurrence of the reperfusion and reocclusion syndrome. RESULTS One hundred patients (27%) underwent TT. It was less frequently applied in older patients, women, and patients with previous myocardial infarction. Reperfusion was achieved in 66 (66%) patients and reocclusion occurred in 9 (14%). Final outcome was successful in 57 (57%) patients. The TT group had more frequent arrhythmias (67% vs. 41%, p<0.001) and less frequent heart failure (20% vs. 39%, p<0.001) than the patients without TT. The mortality after TT was significantly lower (7% vs. 17%, p=0.015), without fatal outcome in patients with finally successful TT. Reasons against TT application were late arrival to hospital (51%) and contraindications for TT (34%). In patients without TT, the median pain-to-door time and door-to-needle time were significantly longer than in the TT group (7 vs. 2.5 hours and 55 vs. 20 min, respectively; p<0.001). CONCLUSION Older age, female gender, previous myocardial infarction, and late arrival to the CCU negatively influence the use of TT in AMI. TT should be improved by shortening pain-to-door time, broadening indications, and limiting contraindications.