• L Zaputović, Z Mavrić, B Mlinarić, Z Kupanovac, A Matana, and D Marinović.
• Department of Internal Medicine, University Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia. luka.zaputovic@mamed.medri.hr
• Croat. Med. J. 2000 Dec 1; 41 (4): 401-5.

AimTo investigate the eligibility of patients with acute myocardial infarction (AMI) for thrombolytic therapy (TT) and evaluate the results of treatment.MethodsRetrospective analysis included 366 patients with AMI, mean age 66+/-11 years, treated in 1999. We analyzed age, gender, previous infarction, previous TT, present TT with streptokinase and its effects on the course and outcome, pain-to-door time, and door-to-needle time. Reperfusion and reocclusion were evaluated non-invasively according to the occurrence of the reperfusion and reocclusion syndrome.ResultsOne hundred patients (27%) underwent TT. It was less frequently applied in older patients, women, and patients with previous myocardial infarction. Reperfusion was achieved in 66 (66%) patients and reocclusion occurred in 9 (14%). Final outcome was successful in 57 (57%) patients. The TT group had more frequent arrhythmias (67% vs. 41%, p<0.001) and less frequent heart failure (20% vs. 39%, p<0.001) than the patients without TT. The mortality after TT was significantly lower (7% vs. 17%, p=0.015), without fatal outcome in patients with finally successful TT. Reasons against TT application were late arrival to hospital (51%) and contraindications for TT (34%). In patients without TT, the median pain-to-door time and door-to-needle time were significantly longer than in the TT group (7 vs. 2.5 hours and 55 vs. 20 min, respectively; p<0.001).ConclusionOlder age, female gender, previous myocardial infarction, and late arrival to the CCU negatively influence the use of TT in AMI. TT should be improved by shortening pain-to-door time, broadening indications, and limiting contraindications.

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