Thrombolytic therapy in acute myocardial infarction: Experience at a university hospital in Kuwait.

BACKGROUND

There is conclusive evidence from large clinical trials that thrombolytic therapy reduces mortality and morbidity in acute myocardial infarction (AMI). However, only a small proportion of patients receive thrombolytic treatment. Estimates have varied from 20%-50% in North America and Europe. Data from the Arab Middle East is sparse. The purpose of our study was to determine the use of thrombolytic therapy in our hospital.

METHODS

We conducted a retrospective analysis of 343 patients (358 incidents of AMI), who were either discharged from or died at the coronary care unit of the Mubarak Al-Kabeer Hospital during the one-year period between June 1994 and May 1995.

RESULTS

Our patients were relatively younger (63% were 7lt;55 years) and had a much higher prevalence (44%) of diabetes compared to European patients. We observed a high rate (62%) of thrombolysis and a lesser shortfall (8%) when compared to that reported for European patients. The main reason for withholding thrombolytic therapy was non-diagnostic electrocardiogram (ECG) on initial presentation. Women were less likely to be thrombolyzed than men (38% vs. 66%, P=0.0001). Older patients (aged >65 years) were also less likely to be thrombolyzed than younger patients (42% vs. 66%; P=0.0006).

CONCLUSION

We conclude that the use of thrombolytic therapy in this university hospital in Kuwait is appropriate. However, as observed in other reports as well, the underutilization of thrombolytic therapy in women and the elderly needs to be addressed in future studies.