Behar S, Gottlieb S, Hod H, Benari B, Narinsky R, Pauzner H, Rechavia E, Faibel H E, Katz A, Roth A, Goldhammer E, Freedberg N A, Rougin N, Kracoff O, Shapira C, Jafari J, Lotan C, Daka F, Weiss T, Kanetti M, Klutstein M, Rudnik L, Barasch E, Mahul N, Blondheim D
Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel.
Am J Med. 1996 Aug;101(2):184-91. doi: 10.1016/s0002-9343(96)80075-1.
The aim of this study was to determine the proportion of patients with acute myocardial infarction (AMI) excluded from thrombolytic therapy on a national basis and to evaluate the prognosis of these patients by reasons of ineligibility and according to the alternative therapies that they received during hospitalization.
During a national survey, 1,014 consecutive patients with AMI were hospitalized in all the 25 coronary care units operating in Israel.
Three hundred and eighty-three patients (38%) were treated with a thrombolytic agent and included in the GUSTO study. Ineligible patients for GUSTO were treated: (1) without any reperfusion therapy (n = 449), (2) by mechanical revascularization (n = 97), or (3) given 1.5 million units of streptokinase (n = 85) outside of the GUSTO protocol. The inhospital and 1-year post-discharge mortality rates were 6% and 2% in patients included in the GUSTO study; 6% and 5% in those mechanically reperfused; 15% and 10% in those treated with thromoblysis despite ineligibility for the GUSTO trial, and 15% and 13% among patients not treated with any reperfusion therapy.
Ineligibility for thrombolysis among patients with AMI remains high. Patients ineligible for thrombolysis according to the GUSTO criteria, but nevertheless treated with a thrombolytic agent were exposed to an increased risk.
