Abstract
Multiple thrombolytic agents are available for treating patients with acute myocardial infarction. The recently completed Global Utilization of Streptokinase and rt-PA for Occluded coronary arteries (GUSTO) study randomized 41,000 patients to 1 of 4 thrombolytic treatment regimens. Straub Clinic and Hospital, a small community hospital in Hawaii, participated in this international clinical trial enrolling a total of 40 patients. Our patient characteristics and use of concomitant therapy were similar to the combined GUSTO, study results. Coronary angiography was performed in 93% of patients postthrombolytic therapy, with a majority of patients having single vessel coronary disease and a patent infarct-related artery. The severity of coronary artery disease at our hospital was similar to the combined GUSTO study results. Percutaneous transluminal coronary angioplasty was performed in 53% of patients and coronary artery bypass surgery in 13% of patients postthrombolytic therapy at our hospital, compared to 15% and 9% in the combined GUSTO study, respectively. The clinical events postthrombolytic therapy at Straub Clinic and Hospital were similar to the combined GUSTO study results, except for a lower incidence of ischemia/reinfarction at our hospital (7.5% v 23.2% respectively).
These data suggest that treatment of acute myocardial infarction with thrombolytic therapy can be administered in a safe and timely manner at a small community hospital.
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