Thrombolytic therapy in acute myocardial infarction : the Bahrain experience 1988-1995

الملخص EN

Objective and Settings : To study the outcome after thrombolytic therapy for acute myocardial infarction (AMI) at Salmaniya Medical Centre (SMC), which is the premier referral centre in Bahrain.

Five year average pre-thrombolytic era mortality' after AMI at SMC provided a base-line (10.9 %).

Design : Review of medical records of all 686 patients who received thrombolytic therapy for AMI from April 1988 to March 1995 either with 100 mg tissue plasminogen activator (t-PA) or 1.5 million units streptokinase (SK).

Results : Bahrainis constituted 44.9 % of the patients, rest being expatriates.

Mean age was 50.2 (SD 11.2) years; 48.9 (SD 11) years among males and 59.9 (SD 7.7) years among females (M:F = 7:1).

Base-line risk factors were: smoking 60.5 %, hrtriglyceridemia 40.2 %, hypercholesterolemia 32.2 %, diabetes mellitus 31.7 %, systemic hypertension 20.1 %, previous angina 13.9 % and family history of ischaemic heart disease 10.9 % Non-cerebral bleeds occurred in 5.8 % (8.9 % with t-PA, 3.7 ٠/« with SK, p = 0.004).

With t-PA the incidence oftotal strokes and haemorrhagic strokes were 1.8 % and 1.4 % with t-PA and with SK 1.5 % and 1.2 % with SK (p = NS).

Bahraini females had a higher incidence of post-thrombolytic strokes (7.1 %) than Bahraini males (0.4 %, p = 0.01

The total in-hospital mortality and 24 hour mortality were 4.4 ٠/» and 2.8 % respectively, with no statistically significant difference between t-PA and SK.

Females had a higher total in-hospital mortality (11.9 %) than males (3.4 %, p = 0.0004).

Conclusion : Thrombolytic therapy utilisation has more than halved (59.6 % reduction) the in-hospital mortality for AMI at SMC, with acceptable safety profile, except for the higher risk of post-thrombolytic strokes in Bahraini females.