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December 2, 1992, Vol 268, No. 21 >
ARTICLE | December 2, 1992

Thrombolytic Therapy of Acute Myocardial Infarction: Title and subTitle BreakKeeping the Unfulfilled Promises FREE

Andrew J. Doorey, MD; Eric L. Michelson, MD; Eric J. Topol, MD
[+] Author Affiliations

Presented in part at the 65th Scientific Session of the American Heart Association, New Orleans, La, November 18, 1992.

Reprint requests to Medical Center of Delaware, 4745 Ogletown-Stanton Rd, Suite 220, Newark, DE 19713 (Dr Doorey).


JAMA. 1992;268(21):3108-3114. doi:10.1001/jama.1992.03490210090041
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References

Objective.  —To assess the use of thrombolytic therapy for acute myocardial infarction, evaluating whether inclusion and exclusion criteria should be altered as well as the public health implications of any such alterations.

Data Sources.  —Data obtained were from English-language articles on the use of thrombolytic therapy in acute myocardial infarction. Articles that reported on inclusion and exclusion criteria as well as specific complications of this therapy were specifically sought. The review included articles under the terms thrombolytic therapy and acute myocardial infarction in the National Library of Medicine's MEDLINE database.

Study Selection.  —Studies selected for detailed review were those reporting specifics about inclusion and exclusion criteria and efficacy. Data extraction guidelines for assessing data quality included study size, patient population, detail of patient information acquired, and consecutive patient enrollment.

Data Synthesis.  —Thrombolytic therapy can provide substantial decrements of morbidity and mortality of acute myocardial infarction in the subset of patients who receive this therapy, but is underused in the United States. Advanced age per se should not be an exclusion criterion. Improvements can be made in electrocardiographic diagnosis of acute myocardial infarction. Many of the clinical conditions initially excluded from thrombolytic consideration, such as hypertension or having received cardiopulmonary resuscitation, are only relative contraindications. The benefit/risk ratio in treatment of these patients is often acceptable. Several well-documented points of delay from onset of symptoms to treatment can be minimized, and accelerated therapy can result in a reduction in mortality rates.

Conclusion.  —Significant public health benefits will result from greater use of thrombolytic therapy in acute myocardial infarction.(JAMA. 1992;268:3108-3114)

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
References 15, 19, 23, 24, 28, 30, 32, 34, 36, 38.
2 +
Braunwald E.  Optimizing thrombolytic therapy of acute myocardial infarction. Circulation . 1990;; 82:1510-1513.
3 +
ISIS-2 (Second International Study of Infarct Survival) Collaborative Group.  Randomised trial of intravenous streptokinase, oral aspirin, both or neither among 17 187 cases of suspected acute myocardial infarction: ISIS-2. Lancet . 1988;;2:349-360.
4 +
AIMS Trial Study Group.  Long-term effects of intravenous anistreplase in acute myocardial infarction: final report of the AIMS study. Lancet . 1990;;335:427-431.
5 +
Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI).  Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet . 1986;;1:397-402.
6 +
Wilcox RG, Olsson CG, Skene AM, et al.  Effects of alteplase in acute myocardial infarction: 6-month results from the ASSET Study. Lancet . 1990;;335: 1175-1178.
7 +
Kennedy JW, Ritchie JL, Davis KB, Stadius ML, Maynard C, Fritz JK.  The Western Washington Randomized Trial of Intracoronary Streptokinase in Acute Myocardial Infarction: a twelve-month follow-up report. N Engl J Med . 1985;;312:1073-1078.
8 +
Doorey AJ, Michelson EL, Weber FJ, Dreifus LS.  Thrombolytic therapy of acute myocardial infarction: emerging challenges of implementation. J Am Coll Cardiol . 1987;;10:1357-1360.
9 +
Lee TH, Weisberg MC, Brand DA, Rouan GW, Goldman L.  Candidates for thrombolysis among emergency room patients with acute chest pain. Ann Intern Med . 1989;;110:957-622.
10 +
Murray N, Lyons J, Layton C, Balcon R.  What proportion of patients with myocardial infarction are suitable for thrombolysis? Br Heart J . 1987;;57: 144-147.
11 +
Eisenberg MS, Ho MT, Schaeffer S, et al.  A community survey of the potential use of thrombolytic agents for acute myocardial infarction. Ann Emerg Med . 1989;;18:838-841.
12 +
Hlatky MA, Cotugno H, O'Connor C, Mark DB, Pryor DB, Califf RM.  Adoption of thrombolytic therapy in the management of acute myocardial infarction. Am J Cardiol . 1988;;61:510-514.
13 +
Behar S, Abinader E, Caspi A, et al.  Frequency of use of thrombolytic therapy in acute myocardial infarction in Israel. Am J Cardiol . 1991;;68:1291-1294.
14 +
Cragg DR, Friedman HZ, Bonema JD, et al.  Outcome of patients with acute myocardial infarction who are ineligible for thrombolytic therapy. Ann Intern Med . 1991;;115:173-177.
15 +
Althouse R, Maynard C, Cerqueira MD, Olsufka M, Ritchie JL, Kennedy JW.  The Western Washington Myocardial Infarction Registry and Emergency Department Tissue Plasminogen Activator Treatment Trial. Am J Cardiol . 1990;;66:1298-1303.
16 +
Grines CL, DeMaria AN.  Optimal utilization of thrombolytic therapy for acute myocardial infarction: concepts and controversies. J Am Coll Cardiol . 1990;;16:223-231.
17 +
Pfeffer MA, Moyé LA, Braunwald E, et al.  Selection bias in the use of thrombolytic therapy in acute myocardial infarction. JAMA . 1991;;266:528-532.
18 +
Behar S.  Implementation of thrombolytic therapy in patients with acute myocardial infarction. Circulation . 1991;;84:II-63. Abstract.
19 +
Von der Leyen H, Spyridopoulos I, Jabbarian S, Gulba DC, Lichtlen PR.  Impact of thrombolysis on the overall mortality of acute transmural myocardial infarction in hospitalized patients. Circulation . 1991;;84:II-62. Abstract.
20 +
Muller DWM, Topol EJ.  Selection of patients with acute myocardial infarction for thrombolytic therapy. Ann Intern Med . 1990;;113:949-960.
21 +
American Heart Association. 1991 Heart and Stroke Facts . Dallas, Tex: American Heart Asociation; 1991;.
22 +
Smith SC Jr, Gilpin E, Ahnve S.  Outlook after acute myocardial infarction in the very elderly compared with that in patients aged 65 to 75 years. J Am Coll Cardiol . 1990;;16:784-792.
23 +
Adolph RJ.  The elderly, the very elderly and traditional practice patterns. J Am Coll Cardiol . 1990;;16:793-794.
24 +
Topol EJ, Califf RM.  Thrombolytic therapy for elderly patients. N Engl J Med . 1992;;327:45-47.
25 +
Montague TJ, Ikuta RM, Wong RY, Bay KS, Teo KK, Davies NJ.  Comparison of risk of patterns of practice in patients older and younger than 70 years with acute myocardial infarction in a two-year period (1987-1989). Am J Cardiol . 1991;;68: 843-847.
26 +
Weaver WD, Litwin PE, Martin JS, et al.  Effect of age on use of thrombolytic therapy and mortality in acute myocardial infarction. J Am Coll Cardiol . 1991;;18:657-662.
27 +
Wittry MD, Thornton TA, Chaitman BR.  Safe use of thrombolysis in the elderly. Geriatrics . 1989;; 44:28-36.
28 +
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Battle R, Capeless M, Langburd A, Ditchey R.  Posterior leads detect myocardial injury during circumflex coronary artery occlusion. J Am Coll Cardiol . 1991;;17:311A. Abstract.
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Chop WM, Evans PJ, Felty K.  Thrombolytic therapy during active menstruation: a case report. J Fam Pract . 1991;;33:79-81.
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Califf RM, Fortin DF, Tenaglia AN, Sane DC.  Clinical risks of thrombolytic therapy. Am J Cardiol . 1992;;69( (suppl A) ):12A-20A.
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Sleight P. ISIS-3 'uncertain' arm: thrombolysis versus control: which patients benefit from lytic therapy? Presented at the Seventh International Workshop on Thrombolysis and Interventional Therapy in Acute Myocardial Infarction; November 10, 1991; Anaheim, Calif.
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Sloan MA, Gore JM.  Ischemic stroke and intracranial hemorrhage following thrombolytic therapy for acute myocardial infarction: a risk/benefit analysis. Am J Cardiol . 1992;;69:21A-38A. Abstract.
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Anderson JL, Karagounis L, Allen A, Bradford MJ, Menlove RL, Pryor TA.  Older age and elevated blood pressure are risk factors for intracerebral hemorrhage after thrombolysis. Am J Cardiol . 1991;; 68:166-170.
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Kase CS, O'Neal AM, Fisher M, Girgis GN, Ordia JI.  Intracranial hemorrhage after use of tissue plasminogen activator for coronary thrombolysis. Ann Intern Med . 1990;;112:17-21.
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DeJaegere PP, Arnold AA, Balk AH, Simoons ML.  Intracranial hemorrhage in association with thrombolytic therapy: incidence and clinical predictive factors. J Am Coll Cardiol . 1992;;19:289-294.
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Leizorovicz A, Boissel JP, Robert F.  Coronary reperfusion rate in acute myocardial infarction after fibrinolytic treatment is correlated with the delay onset of symptoms to treatment. Circulation . 1990;;82:III-255. Abstract.
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Wasserman AG, Ross AM.  Patient selection for thrombolytic therapy . Am J Cardiol . 1989;;64( (suppl B) ):17B-21B.
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