The results suggest that national guidelines on the use of these drugssuch as streptokinase and tissue plasminogen activator (t-PA)should be applied with greater selectivity, and possibly revised, to maximize benefit and minimize risk due to bleeding or stroke, said lead author Stephen Soumerai, professor of ambulatory care and prevention at Harvard Medical School and Harvard Pilgrim Health Care. Co-authors of the article, which appears in the March 11 Archives of Internal Medicine, include two of Soumerais colleagues in the HMS/HPHC Department of Ambulatory Care and Prevention, assistant professor Thomas McLaughlin and associate professor Dennis Ross-Degnan, along with collaborators from Boston University School of Public Health and the University of Massachusetts Medical School. The study was funded by the National Institute on Aging of the National Institutes of Health.
The researchers examined records of 2,659 patients with acute myocardial infarction admitted to 37 Minnesota community hospitals from 1992 to 1996. Of this group, 719 patients were eligible for thrombolytic therapy according to the guidelines, which rely on time from symptom onset (under 12 hours), electrocardiograph readings, and absence of contraindications such as trauma, bleeding, or extremely high blood pressure.
In the study, about 63 percent of eligible patients and 14 percent of ineligible patients received the drugs. Thrombolytic therapy was associated with reduced mortality among eligible patients younger than 80 years, but with increased mortality in
Contact: John Lacey
Harvard Medical School