CLINICAL IMPACT OF INTRODUCING THROMBOLYTIC AND ASPIRIN THERAPY INTO THE MANAGEMENT POLICY OF A CORONARY-CARE UNIT

PURPOSE: To evaluate the impact of introducing thrombolytic and aspirin therapy into the management policy of a coronary care unit, with particular reference to its effects on the hospital course of nonselected patients with acute myocardial infarction. End points chosen were the utilization of thrombolytic and aspirin therapy, hospital mortality, discharge diuretic requirements, and the incidence of ventricular fibrillation and cardiogenic shock. PATIENTS AND METHODS: A total of 336 patients with acute myocardial infarction were studied, comprising consecutive admissions to the coronary care unit over two separate 12-month periods: January to December 1986 (n = 158) and September 1989 to August 1990 (n = 178), before and after thrombolytic and aspirin therapy had been introduced into the management policy of the unit. RESULTS: Thrombolytic and aspirin therapy was given to 87% and 93%, respectively, of all patients in the 1989/1990 cohort. This high treatment rate led to substantial improvements in morbidity and mortality. Thus, comparison of the 1986 and 1989/1990 cohorts showed reductions in hospital mortality (24% to 11%, p < 0.005), ventricular fibrillation (22% to 13%, p = 0.05), and cardiogenic shock (20% to 6%, p < 0.001), particularly in patients aged over 60. Reductions in the incidence of lesser degrees of heart failure are reflected in the proportions of patients discharged with diuretic requirements, which declined from 43% in 1986 to 22% in 1989/1990 (p < 0.001). The duration of hospital stay for patients who survived showed no change between 1986 and 1989/1990, but time spent in the coronary care unit decreased from 3.1 +/- 1.8 to 2.1 +/- 1.4 days (p < 0.001). CONCLUSION: The great majority of nonselected patients with acute myocardial infarction are candidates for thrombolytic and aspirin therapy, which can be given safely, leading to profound reductions in mortality and the incidence of major complications, particularly in the older age group.