A population-based assessment of the use and effectiveness of thrombolytic therapy: The Corpus Christi Heart Project

Little is known regarding the use and effectiveness of thrombolytic therapy in community settings, especially regarding the receipt of therapy by Mexican Americans. Thus, we examined the factors associated with receipt of thrombolysis and the survival experience of recipients and nonrecipients in the Corpus Christi Heart Project. The Corpus Christi Heart Project is a population-based surveillance program for hospitalized myocardial infarction among Mexican-American and non-Hispanic white women and men residing in Corpus Christi, Texas. Multivariate regression analyses were used to identify factors associated with receipt of thrombolytic therapy and to assess the association between receipt of thrombolytic therapy and mortality. During a 2-year period, 1199 patients hospitalized for myocardial infarction were identified; 159 (13.3%) received thrombolysis. Among “ideal” candidates for thrombolytic therapy, 74 (35.1%) of 211 received such therapy. Women were less likely to receive thrombolysis than men, and Mexican Americans were less likely to received thrombolysis than non-Hispanic whites. Patients for whom there was a delay of more than 4 hours between onset of symptoms and arrival at the hospital were also less likely to receive thrombolysis. Recipients of thrombolytic therapy experienced lower mortality over 56 months following myocardial infarction than did nonrecipients (20.5 versus 33.2%, P < 0.01). Use of thrombolytic therapy was less frequent among women and Mexican Americans than among men and non-Hispanic whites, and was limited by delay between onset of symptoms and arrival at the hospital. Given the apparent benefit of thrombolysis, interventions should be designed to educate physicians regarding the need to make this therapy available to all appropriate patients with myocardial infarction regardless of sex or ethnicity and to educate the public to reduce the delay in seeking health care after the onset of cardiac symptoms.