Thrombolytic treatment in the management of acute myocardial infarction. Experience in San Jose, CR.
DOI:
https://doi.org/10.51481/amc.v39i2.605Keywords:
trombolisis, infarto agudo del miocardio, estreptoquinasa, terapia de reperfusiónAbstract
Objectives: Thrombolytic agents are considered first line drugs in the management of acute myocardial infarction (AMI), and therefore they must be given as early as possible after the onset of symptoms. They are available for clinical use in Costa Rica since 1986, however, it is important to know how often they are used, how early since the onset of symptoms and the reasons why they are not given in many cases.
Methods: This is a partial report from a prospective, descriptive and multicenter study aimed at assessing the current management of AMI in 4 Latin American countries including Costa Rica. It was carried out in 3 Hospitals from the Metropolitan Area of San José from November 1st, 1993 until September 4th, 1994. A standardized questionnaire was filled out by the investigators during the hospitalization of the patients studied. All the patients admitted to the hospitals with symptoms of AMI within the first 24 hours after the onset of symptoms were included. The diagnosis of AMI was made by the admitting physicians and the investigators did not participate in their management.
Results: 201 patients with AMI were studied. Average age was 59.2 years, of which 53.7% received thrombolytic therapy (intravenous SK). The mean time interval between the onset of
symptoms and arrival to the hospital was 8.2 hours with a median of Il hours. 108 patients received SK, they arrived to. the hospital in a mean time interval of 6.27 hours with a median of 5.3 hours. The reasons why in many patients SK was not administered were: time interval between onset of symptoms and diagnosis of AMI longer than 6 hours in 47 patients, age over 70 in 18 cases, and in eleven patients there were no obvious contraindications for SK despite the fact that the diagnosis of AMI was done in less than 6 hours since the onset of symptoms.
Conclusions: More than 50% of the patients with AMI received SK. However, in general, the time lapsed between the onset of symptoms and the hospital arrival was over 8 hours. If this time lapse could be reduced, a higher percentage of patients would receive SK, and therefore the benefits of the reperfusion therapy would be greater.
Downloads
References
Reeder GS, Gersh BJ. Modern management of acute myocardial infarction.
Curr Problems in Cardiology 1996;21 :591-659.
Gunnar RM, Bourdillon PV'D, Dixon DW', et al ACC/AHA Task Force repolt. Guidelines for the early management of patients with acute miocardial infartion. J Am coli Cardiol 1990.
Fribrinolytic Therapy Trialists' Group. Indications for frinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than patients. Lancet 1994.
Gruppo Italiano Per Lo Studio Della Streptochinasi Nell' Infarto Miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment acute myocardial infarction . Lancet 1986.
Weaver WD, Cerqueria M, Hallstron AP, et al., for the Myocardial Infarction Triage and Intervention Project Group. Prehospital-initial vs hospital initiated thrombolitic therapy. JAMA 1993:270: 1211-16.
Gruppo Italiano per 10 Studio della Sopravvivenza nell' Infalto Miocardico: GISSI-2, A factorial randomized trial of alteplase versus strptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction,Lancet 1990.
ISIS-3 (Third Intenational Study of Infart Survival) Collaborative Group. ISSIS-3: A randomized comparison of streptokinase vs tissue plasnlinogen activator vs anistreplese and of aspirin plus heparin vs aspirin alone alnong 41,299 cases of suspected acute myocardial infarction. Lancet 1992.
The GUSTO investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial. N Engl J Med 1993.
Smalling RW.Molecular biology of plasminogen activators: what are the clinical implications of drug design? Am J Cardiol 1996,
Bode C, Nordt TK,Peter K, Smiling RW, Runge MS, Kubler W. Patency trials with reteplase (r-PA): what do they tell us? Am J Cardiol 1996: 78
The USA myocardial infarction registry. Circulation 1993.
Weaver WD, Cerqueira M, Hallstron AP, et al.. for the MITI (myocardial infarction triage and intervention) Project Group. Early treatment with thrombolytic therapy: results from the myocardial infarction. triage. and intervention prehospital trial. JAMA 1993:270: 1211-6.
Tury ZG. Stone PH, Muller JE, Parker C, Rude RE. Raabe DE.et al.lmplications for acute intervention related to time of hospital arrival in acute Myocardial Infarction. Am J Cardiol. 1986.
Newby LK, Rutsch WR;Ca1iff RM; Simoons ML, Aylward PE. Armstmn,g PW,et al. Time from symptom onset to treatment and outcomes alterthrombolytic therapy. GUSTO-I Investigators. J Am Coll Cardiol. 1996.
Jerry H. Guwitz, MD: Thomas J. Mclaughlin. ScD: Donald J. Willisonet al. Delayed hospital presentation in patients who have had acute myocardial infarction. Ann Intern Med. 1997.
Yarzebski J, Godberg RJ, Gore JM, Alpert JS. Temporal trends and factors associated with extent of delay to hospital arrival in patients with acute myocardial infartion: The Worcester heart Attack Study. Am Heart 1994.
Downloads
Published
Issue
Section
License
Copyright (c) 2010 Acta Médica Costarricense
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Los autores que publican en la revista Acta Médica Costarricense pueden distribuir, copiar, remezclar, retocar, leer, descargar, imprimir, buscar y crear a partir de su obra de modo no comercial, indicando los créditos a la revista y sus autores y compartir su obra en las mismas condiciones. Para ello se aplica la licencia Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional(CC BY-NC-SA 4.0)
