[Management of acute transmural myocardial infarction: a study on 200 patients admitted to a tertiary care medical center].J Med Liban. 2005 Jan-Mar; 53(1):2-8.JM
To verify if the management of acute transmural myocardial infarction in a university hospital, follows the international guidelines of the ACC/AHA.
This is a retrospective study on 200 consecutive patients admitted with an acute transmural myocardial infarction. Data were obtained by review of medical records.
20.5% of patients were treated with primary angioplasty, 44% received thrombolytic therapy and 35.5% a conventional medical treatment. Mean age was 62 +/- 11.64 years and 72% of the patients were males. Risk factors were: smoking 62%, hyperlipidemia 46%, hypertension 43.5%, diabetes 33.5%, obesity 13.5%, and a family history of coronary artery disease 25%. 17.5% of patients had a prior history of myocardial infarction and 4.5% had prior coronary artery bypass graft surgery. The mean delay between onset of symptoms and arrival to the hospital was 12 hours. Chest pain was the main symptom and was present in 88% of patients. Cardiac arrest was observed in 7% of patients upon arrival to the emergency department. Administration of thrombolytic therapy followed the established criteria in all cases. Angioplasty was mainly performed in cases of cardiogenic shock, and as a rescue for failed thrombolytic therapy and for pain recurrence. The two reperfusion modalities were given equally to elderly patients, patients with prior coronary artery bypass surgery and to those with anterior wall myocardial infarction. Coronary angiography was done in 94% of patients, coronary angioplasty was subsequently performed on 30.1%, and bypass surgery on 27%. Mortality rate was 11.2%, and it was significantly higher in patients treated conventionally by comparison with thrombolysis and/or PTCA. Major arrhythmias were observed in 13.5% of cases and infections in 3.5%. Mean length of stay was 2.85 +/- 3.1 days in the intensive care unit and 8.9 +/- 6.7 days in the hospital. Treatment on discharge followed the international recommendations; aspirin was given to 87.5% of patients, beta-blockers to 63.3%, ACE inhibitors to 59% and statines to 32%.
The management of acute transmural myocardial infarction at our institution follows the international guidelines. However, the delay between the onset of symptoms and arrival to the hospital needs to be shortened. Public awareness campaigns should be useful for that purpose. In addition, the treatment on discharge should be improved.