The long term prognosis in patients following thrombolysis for acute myocardial infarction: a view from a community hospital

Thrombolysis in patients with acute myocardial infarction has been established to improve hospital survival. Less information is available about the long term evolution of unselected patients seen in community hospitals. Consequently, consecutive patients treated with thrombolysis for acute myocardial infarction and surviving until hospital discharge (n = 129) were followed for an average of 22 months. Mortality, recurrent ischemic events, coronary angiography and re-vascularizations were recorded for all patients. Two-year total and cardiovascular survival rates of 95 and 98% respectively were obtained with a conservative approach to early re-vascularization (n = 17, 13%). A history of prior myocardial infarction and early recurrent myocardial ischemia were significant predictors of increased cardiac events, while thallium stress testing provided no incremental value. Angiography and re-vascularizations were more frequently performed in younger patients (under 65 years old), anterior vs. inferior infarction and those with early residual ischemia. Women received less aggressive investigation and therapy then men and this may represent a gender bias, unmeasured residual confounding or the play of chance in a small sample size. Further studies are needed to confirm or refute these findings.