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Expanding eligibility for thrombolytic therapy in acute myocardial infarction
Vol. 65, Suppl. 1
ABSTRACTS OF 12TH INTNAT’L CONGRESS
s199
P392 EXPANDING ELIGIBILITY FOR THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL INFARCTION A.Giomi, A.Bar?olo:ci, A.Aljieri, MChiti, F.Fantoni, F.Del Citerna. Coronary Care Unit, Pistoia Hospital, Pistoia, Italy Intravenous thrombolysis (T) improves prognosis of pts with AMI, and its clinical impact increases proportionally to the percentage of pts treated. The aim of our study was to evaluate the percentage of AM1 pts submitted to T at our CCU, and to prospect how eligibility could be expanded by changing selection criteria. Out of 3 18 pts admitted with acute chest pain in 1991, I99 (66 F, age 68~1 I) had a confirmed diagnosis of AMI. 78 of these (25 F, age 66~10), representing the 39%, were treated with T. Age per se was uot a contraindication. All the pts had ST elevation at entry. 90% were treated within 6 hours from the symptoms onset, the remaining 10% between 6 and 9 hours. 19 pts wcrc cxcludcd from trcatmcnt because of contraindications (10 absolute, 9 relative, 5 of which represented by external cardiac massage) Changing the eligibility criteria, the percentage of treated pts should have increased as follows. Extension of the time window to I2 hours: +9% (n=18 pts). Inclusion of pts with LBBB: +I% (n=2). Treatment of pts with relative contraindications: +4,5% (n=9). These criteria would raise the percentage from 39% to S3,5%. Moreover, extending the treatment to the subgroup of pts with uncertain diagnosis (n=18), a further 9% of pts would have been treated, to a total of 62,S%. Our analysis shows a tendency to underutilization of T in our CCU; this is due to the narrow time window and the exclusion of pts with previous external cardiac massage. The treatment of pts with uncertain diagnosis should raise significantly the percentage: however, in this subgroup the risk-benefit ratio is still unclear.
P393 THROMBOLYTIC THERAPY AFFECTS HEART RATE PROFILE IN MYOCARDIAL INFARCTION A. Giomi, A.Aljieri, F.Fantoni, A.Bartoloz3, F. Del Citerna. Coronary Care Unit, Hospital of Pistoia, Italy. In order to evaluate the clinical factors affecting heart rate (HR) behavior in myocardial infarction (MI), we studied 48 consecutive pts (40 males, age 62fi) who underwent Whour Holter monitoring (Oxford Medilog) during the acute and the subacute phase of MI. 22 pts had anterior MI (AMI), 16 inferior MI (IMI), 10 non-Q wave MI (NQMI); 36 underwent thrombolytic therapy (TT-yes), while 12 did not (TT-no) because of contraindications or a latency 212 hours. Recordings were made 18~6 hours from the onset of symptoms and before discharge, when pts were no more restricted to bed. No pts assumed oral beta-blockers or diltiazem. In each pt we calculated the 24-hour mean (HRM), waking (HRW), night-time (HRN), and the circadian profile. CK values were higher in AMI (3647~1869 vs IMI 251221841 and NQMI I 139&64,p~0,005) and TT-no (2977~2312 vs TT-yes 2140&1750,p<0,01) pts: so did the Killip class (AMI 2~1 vs IMI 1,2&,3 and NQMI 1&5,p<0,()5;TT-no l&l,1 vs TT-yes 1,~0,6,p
1
69~8 71s 68~8
* * *
7&l 1 6&lO 7*10 72~10 74&J 1 63&
*
73~12 7&11 * 71fi
7kl2 7&12 1 7wl
5 67;t8 5 68~8 3 -7
6% 6&g 63~4
7Oyll 71210 67&J
67~10 74t10 * 62~8
al 1 7&12 639 1
Anterior MI and TT affect the level and circadian rhytm of HR during the hospital phase of MI.The early HR reduction obtained by TT, perhaps secondary to the better hemodynamic status, is maintained at discharge, allowing less 02 consumption throughout the day.
ABSTRACTS OF 12TH INTNAT’L CONGRESS
s199
P392 EXPANDING ELIGIBILITY FOR THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL INFARCTION A.Giomi, A.Bar?olo:ci, A.Aljieri, MChiti, F.Fantoni, F.Del Citerna. Coronary Care Unit, Pistoia Hospital, Pistoia, Italy Intravenous thrombolysis (T) improves prognosis of pts with AMI, and its clinical impact increases proportionally to the percentage of pts treated. The aim of our study was to evaluate the percentage of AM1 pts submitted to T at our CCU, and to prospect how eligibility could be expanded by changing selection criteria. Out of 3 18 pts admitted with acute chest pain in 1991, I99 (66 F, age 68~1 I) had a confirmed diagnosis of AMI. 78 of these (25 F, age 66~10), representing the 39%, were treated with T. Age per se was uot a contraindication. All the pts had ST elevation at entry. 90% were treated within 6 hours from the symptoms onset, the remaining 10% between 6 and 9 hours. 19 pts wcrc cxcludcd from trcatmcnt because of contraindications (10 absolute, 9 relative, 5 of which represented by external cardiac massage) Changing the eligibility criteria, the percentage of treated pts should have increased as follows. Extension of the time window to I2 hours: +9% (n=18 pts). Inclusion of pts with LBBB: +I% (n=2). Treatment of pts with relative contraindications: +4,5% (n=9). These criteria would raise the percentage from 39% to S3,5%. Moreover, extending the treatment to the subgroup of pts with uncertain diagnosis (n=18), a further 9% of pts would have been treated, to a total of 62,S%. Our analysis shows a tendency to underutilization of T in our CCU; this is due to the narrow time window and the exclusion of pts with previous external cardiac massage. The treatment of pts with uncertain diagnosis should raise significantly the percentage: however, in this subgroup the risk-benefit ratio is still unclear.
P393 THROMBOLYTIC THERAPY AFFECTS HEART RATE PROFILE IN MYOCARDIAL INFARCTION A. Giomi, A.Aljieri, F.Fantoni, A.Bartoloz3, F. Del Citerna. Coronary Care Unit, Hospital of Pistoia, Italy. In order to evaluate the clinical factors affecting heart rate (HR) behavior in myocardial infarction (MI), we studied 48 consecutive pts (40 males, age 62fi) who underwent Whour Holter monitoring (Oxford Medilog) during the acute and the subacute phase of MI. 22 pts had anterior MI (AMI), 16 inferior MI (IMI), 10 non-Q wave MI (NQMI); 36 underwent thrombolytic therapy (TT-yes), while 12 did not (TT-no) because of contraindications or a latency 212 hours. Recordings were made 18~6 hours from the onset of symptoms and before discharge, when pts were no more restricted to bed. No pts assumed oral beta-blockers or diltiazem. In each pt we calculated the 24-hour mean (HRM), waking (HRW), night-time (HRN), and the circadian profile. CK values were higher in AMI (3647~1869 vs IMI 251221841 and NQMI I 139&64,p~0,005) and TT-no (2977~2312 vs TT-yes 2140&1750,p<0,01) pts: so did the Killip class (AMI 2~1 vs IMI 1,2&,3 and NQMI 1&5,p<0,()5;TT-no l&l,1 vs TT-yes 1,~0,6,p
1
69~8 71s 68~8
* * *
7&l 1 6&lO 7*10 72~10 74&J 1 63&
*
73~12 7&11 * 71fi
7kl2 7&12 1 7wl
5 67;t8 5 68~8 3 -7
6% 6&g 63~4
7Oyll 71210 67&J
67~10 74t10 * 62~8
al 1 7&12 639 1
Anterior MI and TT affect the level and circadian rhytm of HR during the hospital phase of MI.The early HR reduction obtained by TT, perhaps secondary to the better hemodynamic status, is maintained at discharge, allowing less 02 consumption throughout the day.