Outcome of patients with acute myocardial infarction who are ineligible for thrombolytic therapy

Article Abstract:

A great advance in the treatment of acute myocardial infarctions (heart attacks) is the use of thrombolytic agents. These are drugs that dissolve blood clots. These blockages in the coronary arteries, which supply the heart itself with blood, are the source of heart attack. The clinical trials that assessed these drugs and led to their approval had very strict inclusion criteria for eligible patients, such as certain age requirements, no history of stroke, blood pressure that is not too high, no recent surgery, and only certain abnormalities on electrocardiogram. Because these study criteria are being applied to the patients who come to the emergency room with heart attacks, only a small fraction of patients with heart attacks are treated with thrombolytic agents. A review of over 1,400 patients arriving at one hospital with a diagnosis of acute myocardial infarction showed that only 230 (16 percent) were treated with a thrombolytic drug. The outcome of these patients was compared with that of the patients who had not received thrombolysis. The overall mortality was 19 percent for those who were not given a thrombolytic compared with 4 percent among those who did receive this drug. The more conditions that a patient had that excluded him from receiving thrombolysis, the more likely he was to die in the hospital. Certain exclusion criteria, such as age, being a premenopausal female, history of previous heart attack or stroke, or arriving at the hospital more than four hours after the onset of chest pain, carried particularly high mortality rates. Because of these high mortality rates, it is recommended that these patients be considered for studies of thrombolytic therapy, as there is a strong possibility that a significant number of lives might be saved. As impressive as the improvement in survival is for those who receive thrombolysis, the therapy cannot improve overall heart attack mortality statistics if only a select few patients are considered as candidates for treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage

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Selection of patients with acute myocardial infarction for thrombolytic therapy

Article Abstract:

Acute myocardial infarction (AMI, heart attack) is a life-threatening condition resulting from an acute occlusion of the arteries supplying blood to the heart (coronary arteries). The subsequent reduction in blood flow to this organ (myocardial ischemia) causes cardiac damage which, if not treated expeditiously, can lead to death. One treatment for AMI is the administration of thrombolytic agents, such as streptokinase or tissue plasminogen activator, which dissolve the arterial occlusion, restoring blood flow. The sooner this therapy is initiated, the better the chances of a full recovery. However, as a result of the stringent criteria to determine eligibility for thrombolytic therapy, relatively few patients actually receive this treatment. Loosening the eligibility criteria would make this beneficial treatment available to a much wider patient population, but it is not known if the risks involved would outweigh the benefits. A review of all relevant published studies reported between 1980 and 1990 was performed to examine the validity of the exclusion criteria and their impact on patient mortality. As an example, in 1984, 675,000 patients were treated in the US for AMI; 33 percent (223,000) should have been eligible for thrombolytic therapy according to current guidelines. In fact, only 18 percent of the patients were afforded thrombolytic therapy. The reasons for failure of the additional 15 percent to undergo thrombolysis are classified and evaluated. In most cases, the reasons included advanced age, hospitalization more than six hours after symptom onset, high blood pressure, recent history of cardiopulmonary resuscitation, unstable angina (chest pains of increasing severity), and suspicion of AMI without confirmatory electrocardiographic evidence. It is concluded that patients in all categories with the exception of the last two would significantly benefit from receiving thrombolytic therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cardiovascular diseases, Complications and side effects

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Carcinoma of the male breast

Article Abstract:

Only 0.5% of the individuals who develop breast cancer in the US are men. Approximately 1,000 US men are diagnosed with breast cancer each year, and 300 will die. Breast cancer occurs mainly in older men, and is more common among men in the US and the UK than among those from other countries. Risk factors for male breast cancer include exposure to ionizing radiation, treatment with estrogen and increases in estrogen levels caused by liver disorders. More than 75% of men with breast cancer develop a painless mass near their nipple. Men with suspected breast cancer should undergo a fine-needle aspiration or surgical biopsy for diagnosis. Men diagnosed with breast cancer should undergo surgery followed by chemotherapy or treatment with tamoxifen for cancer that has spread to the lymph nodes. Men usually respond better to hormone treatment than women.

Care and treatment, Diseases, Breast cancer, Men

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