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[Pharmacologic treatment of acute myocardial infarction: 2 large clinical trials at a central hospital].
Rev Port Cardiol. 1996 Sep; 15(9):617-30, 611.RP

Abstract

OBJECTIVES

To analyse the clinical practice concerning the pharmacological therapy of acute myocardial infarction (AMI), comparing it with the guidelines for the management of AMI and exploring the reasons for its under use or over use.

METHODS

Retrospective analysis of clinical records of patients with the discharge diagnosis of AMI.

LOCATION

A central hospital in the North of Portugal.

SUBJECTS

One hundred and ninety-one patients admitted to the Internal Medicine Department of a central hospital in the North of Portugal between January 1, 1993, and December 31, 1994.

RESULTS

Thrombolytic therapy was performed in 24.1% of the patients. At discharge 32.6% of the patients were on therapy with beta blockers, 68% with angiotensin converting enzyme inhibitors (ACEI) and 88.4% with aspirin. Stepwise logistic regression produced the following odds ratios for the variables significantly associated with: a) thrombolytic therapy: hypertension - 0.38; non-Q wave infarction - 0.17; time between onset of symptoms and hospital admission greater than 6 hours - 0.18; admission to coronary unit - 14.72; b) beta blocker therapy: age > 60 years - 0.23; serum LDH > 1000 U/L - 0.41; diastolic blood pressure > 85 mmHg - 3.73; Killip > 1 - 0.08; concomitant therapy with calcium antagonist - 0.33; previous therapy with beta blocker - 14.87; hospital stay greater than 10 days - 2.67; c) ACEI therapy: anterior wall infarction - 3.07; non Q wave infarction - 0.13; congestive heart failure - 9.36; serum creatinine > or = 15 mg/dl - 0.03.

CONCLUSIONS

Beta blockers and thrombolytic are under used and ACEI overused. The delay in hospital admission is the most important factor opposing the use of thrombolytic therapy, imposing the need for measures that ean reduce this delay. Therapy with beta blockers (highly cost-effective) can be increased by educational intervention among the physicians. The overuse of ACEI can be ascribed to the good results of randomised trials.

Authors+Show Affiliations

Interno Complementar de Medicina Interna do Serviço de Medicina 3 do Hospital de São João.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

por

PubMed ID

9081315

Citation

Fernando, P B., et al. "[Pharmacologic Treatment of Acute Myocardial Infarction: 2 Large Clinical Trials at a Central Hospital]." Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology, vol. 15, no. 9, 1996, pp. 617-30, 611.
Fernando PB, Ferreira A, Dias P, et al. [Pharmacologic treatment of acute myocardial infarction: 2 large clinical trials at a central hospital]. Rev Port Cardiol. 1996;15(9):617-30, 611.
Fernando, P. B., Ferreira, A., Dias, P., Moura, L., Cortez, M., Capucho, R., Maciel, M. J., Brandão, F., & Gomes, M. C. (1996). [Pharmacologic treatment of acute myocardial infarction: 2 large clinical trials at a central hospital]. Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology, 15(9), 617-30, 611.
Fernando PB, et al. [Pharmacologic Treatment of Acute Myocardial Infarction: 2 Large Clinical Trials at a Central Hospital]. Rev Port Cardiol. 1996;15(9):617-30, 611. PubMed PMID: 9081315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Pharmacologic treatment of acute myocardial infarction: 2 large clinical trials at a central hospital]. AU - Fernando,P B, AU - Ferreira,A, AU - Dias,P, AU - Moura,L, AU - Cortez,M, AU - Capucho,R, AU - Maciel,M J, AU - Brandão,F, AU - Gomes,M C, PY - 1996/9/1/pubmed PY - 1996/9/1/medline PY - 1996/9/1/entrez SP - 617-30, 611 JF - Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology JO - Rev Port Cardiol VL - 15 IS - 9 N2 - OBJECTIVES: To analyse the clinical practice concerning the pharmacological therapy of acute myocardial infarction (AMI), comparing it with the guidelines for the management of AMI and exploring the reasons for its under use or over use. METHODS: Retrospective analysis of clinical records of patients with the discharge diagnosis of AMI. LOCATION: A central hospital in the North of Portugal. SUBJECTS: One hundred and ninety-one patients admitted to the Internal Medicine Department of a central hospital in the North of Portugal between January 1, 1993, and December 31, 1994. RESULTS: Thrombolytic therapy was performed in 24.1% of the patients. At discharge 32.6% of the patients were on therapy with beta blockers, 68% with angiotensin converting enzyme inhibitors (ACEI) and 88.4% with aspirin. Stepwise logistic regression produced the following odds ratios for the variables significantly associated with: a) thrombolytic therapy: hypertension - 0.38; non-Q wave infarction - 0.17; time between onset of symptoms and hospital admission greater than 6 hours - 0.18; admission to coronary unit - 14.72; b) beta blocker therapy: age > 60 years - 0.23; serum LDH > 1000 U/L - 0.41; diastolic blood pressure > 85 mmHg - 3.73; Killip > 1 - 0.08; concomitant therapy with calcium antagonist - 0.33; previous therapy with beta blocker - 14.87; hospital stay greater than 10 days - 2.67; c) ACEI therapy: anterior wall infarction - 3.07; non Q wave infarction - 0.13; congestive heart failure - 9.36; serum creatinine > or = 15 mg/dl - 0.03. CONCLUSIONS: Beta blockers and thrombolytic are under used and ACEI overused. The delay in hospital admission is the most important factor opposing the use of thrombolytic therapy, imposing the need for measures that ean reduce this delay. Therapy with beta blockers (highly cost-effective) can be increased by educational intervention among the physicians. The overuse of ACEI can be ascribed to the good results of randomised trials. SN - 0870-2551 UR - https://www.unboundmedicine.com/medline/citation/9081315/[Pharmacologic_treatment_of_acute_myocardial_infarction:_2_large_clinical_trials_at_a_central_hospital]_ L2 - https://medlineplus.gov/heartattack.html DB - PRIME DP - Unbound Medicine ER -