Fibrinolytic treatment in suspected acute myocardial infarction - Use and risks in clinical practice

Objectives: To study the adherence to guidelines concerning fibrinolytic treatment of patients with suspected myocardial infarction and to obtain information on severe adverse events in clinical practice. Methods: Prospective reporting of all patients admitted for suspected acute myocardial infarction during 4 months in 1994 from 69 (73.4% of all) Swedish coronary care units. Results: The study covers 10 652 admissions, representing 9726 patients. The mean percentage treated with fibrinolytic drugs of patients with a positive ECG (ST-elevation and/or bundle branch block), a delay < 12 h and no contraindications was 56%. The interhospital range was 18.1-94.1%. Fibrinolytic drugs were given with a delay time > 24 h in 12.5% of women and 15.7% of men, and 36.1% of patients with verified acute myocardial infarction were given fibrinolytic drugs. Streptokinase was used in 82.7% and alteplase in 15.5% of the patients, respectively (interhospital range 0-53.3%). Conclusions: Fibrinolytic therapy seems to be used in a non-rational way at several hospitals. Local quality systems may be a way to assure better care.