Selection bias in the use of thrombolytic therapy in acute myocardial infarction

Article Abstract:

Thrombolytic therapy in the treatment of heart attack involves drugs that prevent and dissolve blood clots that block coronary arteries. Studies have shown that, for selected patients, when such therapy is given during the acute phase of a heart attack survival rates are higher. Not all heart attack patients are suitable for this treatment, however, and in fact only a minority of such patients are selected for it. This study examined whether there was any bias in the way patients were chosen for thrombolytic therapy. Data from 2,231 patients participating in the Survival and Ventricular Enlargement (SAVE) study were examined. All patients suffered from poor function of the left ventricle (the heart's main pumping chamber) and were evaluated for thrombolytic therapy using captopril. The characteristics of those chosen and not chosen for therapy were compared; 733 (32.9 percent) of the patients were chosen for thrombolysis. Those not chosen tended to have a higher risk for a poorer outcome from the heart attack. This group tended to be older, to have a prior history of heart problems, and to have a lower functional capacity. Those with other disease, such as diabetes, were less likely to receive the treatment, as were females. Patients who were selected for the SAVE study on the basis of criteria other than electrocardiographic indications of a heart attack were less likely to receive thrombolytic therapy. These results indicate that patients not chosen for thrombolytic therapy have a higher risk for various heart problems than those chosen for it. The use of this therapy in high-risk individuals, except for those with specific contraindications for the therapy, should be considered more closely. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration, Fibrinolytic agents, Thrombolytic drugs

---

Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the survival and ventricular enlargement trial

Article Abstract:

Long-term treatment with captopril may prevent cardiovascular events and increase survival in heart attack patients with asymptomatic left ventricular dysfunction. In patients with left ventricular dysfunction, the heart is not capable of pumping enough blood to the body. Of 2,231 heart attack patients with asymptomatic left ventricular dysfunction, 1,115 were treated with captopril and 1,116 received a placebo, an inactive substance, over an average of 42 months. Twenty percent of the patients treated with captopril died, compared with 25% of those who received a placebo. Eighty-four percent of the patients died from a cardiovascular cause. Treatment with captopril decreased the risk of death from all causes by 19%, and the risk of death from cardiovascular causes by 21%. Patients who have survived a heart attack have a higher risk of a heart attack or another cardiovascular event, compared to other individuals.

Health aspects, Abnormalities, Drug therapy, Heart ventricle, Left, Left heart ventricle, Captopril

---

A comparison of management patterns after acute myocardial infarction in Canada and the United States

Article Abstract:

Survival rates after a heart attack are similar in the US and Canada even though Canadian doctors are less likely to treat heart attack patients with drugs, angioplasty or coronary bypass surgery. Data were collected on 1,573 patients diagnosed with a heart attack at 93 US hospitals and 658 similar patients in 19 Canadian hospitals. The Americans were more likely to be given drugs such as beta-blockers, nitrates and calcium channel blockers. They were also more likely to undergo coronary angiography as well as heart surgery and angioplasty. However, rates of survival and recurrent heart attack were similar to those of the Canadian patients. The Canadian patients were more likely to have angina (chest pain) that limited their activity. Canadian physicians may be more reluctant to use resources because of the way Canadian health care is financed.

Canada, Medical care, Practice, Physicians, Medical professions

Similar abstracts:

• Abstracts: Clinical controversies surrounding thrombolytic therapy in acute myocardial infarction. Thrombolytic therapy: then and now
• Abstracts: Effect of intravenous streptokinase on early mortality in patients with suspected acute myocardial infarction
• Abstracts: Effectiveness of ofloxacin in the treatment of Chlamydia trachomatis and Neisseria gonorrhoeae cervical infection. part 2
• Abstracts: Sensitivity to triazolam in the elderly. Use of benzodiazepines in anxiety disorders. Differential impairment of triazolam and zolpidem clearance by ritonavir
• Abstracts: Management of fetal hemolytic disease by cordocentesis; I. prediction of fetal anemia. part 2 Diverse maternal and fetal pathology associated with absent diastolic flow in the umbilical artery of high-risk fetuses

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.