ArticleBritish heart journal1995
Selection factors for the use of thrombolytic treatment in acute myocardial infarction: a population based study of current practice in the United Kingdom. The European Secondary Prevention Study Group.
Article in British heart journal, 1995. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
3 citing papers in PubMed, 18 citations in OpenAlex.
- Chest pain and left bundle branch block.Proceedings (Baylor University. Medical Center) · 2001Article
- Suspected myocardial infarction and left bundle branch block: electrocardiographic indicators of acute ischaemia.Journal of accident & emergency medicine · 1999Article
- Utilisation of thrombolytic therapy in older patients with myocardial infarction.Drugs & aging · 1998Review
Corrections and comments
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Authors and funding
2 authors at 1 institution in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
objectivesTo identify and rank the factors that currently limit the use of thrombolytic treatment in patients admitted to hospital with acute myocardial infarction.
designWeighted sampling study with retrospective data retrieval from clinical records.
settingAll hospitals within the Trent region providing acute general medical services. PATIENTS: Random sample of 420 patients admitted during February-April 1993 who had acute myocardial infarction as the main discharge diagnosis.
main outcome measuresTreatment odds ratios (and 95% confidence intervals (CI)) for the use of thrombolysis in patient groups defined by relevant clinical characteristics.
resultsThe patient population was older and less likely to have ST segment elevation on the initial electrocardiogram than patients entered into the randomised trials of thrombolysis. Thrombolytic treatment was given to 49% of patients (SE 2.4%). After controlling for negative associations with a history of stroke (treatment odds ratio 0.18 (95% CI 0.04 to 0.53)) and peptic ulcer (odds ratio 0.52 (95% CI 0.26 to 1.01)) use of thrombolysis decreased with increasing patient age. This was particularly noticeable for those aged > 74 years (odds ratio 0.17 (95% CI 0.05 to 0.51)) relative to those aged < 65 years. Thrombolysis was less likely to be used in patients with ST depression (odds ratio 0.22 (95% CI 0.11 to 0.41)) or bundle branch block (odds ratio 0.18 (95% CI 0.07 to 0.44)) than in those with ST elevation on the initial electrocardiogram. Delay from symptom onset to admission was more than 12 h in 15% of patients.
conclusionsThe patient population admitted to hospital with acute myocardial infarction differs in several respects from the samples that have been included in the trials of thrombolysis. The main factors limiting wider use of thrombolysis are diagnostic uncertainty at admission and delayed presentation. Perceived clinical contraindications to treatment are of lesser importance. There is evident reluctance to use thrombolytic treatment in older patients, who were substantially under-represented in the clinical trials.
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