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CZECH MEDICAL ASSOCIATION J. Ev. PURKYNĚ |
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Česky / Czech version | Vnitř. Lék., 48, 2002, No. 2, p. 112-119 |
Diagnosis and Causes of Non-implementation of Thrombolytic Treatment in Patients with Acute
Myocardial Infarction Cagáň S., Jurkovičová O., Moťovská Z., Wimmerová S., Besedová I., Trnovec T.: Ústav preventívnej a klinickej medicíny, Bratislava, Slovenská republika, riaditeľ doc. MUDr. Štefan Nyulassy, DrSc. I. interná klinika Slovenskej postgraduálnej akadémie medicíny, Bratislava, Slovenská republika, prednosta prof. MUDr. Milan Pavlovič, CSc IV. interná klinika Lekárskej fakulty UK, Bratislava, Slovenská republika, prednosta prof. MUDr. Peter Ponťuch, CSc. |
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Summary: In Slovakia we are lacking data on early (before examination of serum markers of myocardial
necrosis) pertaining to thrombolytic treatment (TLL) which is inevitable in case of acute myocardial infarction (AIM) as well as data on the reasons why TLL is not implemented. This why the
authors analyze the results of completed comprehensive project Audit concerned with diagnostic
and therapeutic procedures in patients with acute coronary syndromes during the pre-hospital
and hospital stage (AUDIT). The investigation was a perspective multi-centre study. Data were
collected from 3123 patients with AIM in 66 departments (in 64 health institutions) during Sept.16
1997 till Sept. 15 1998. The group included patients admitted within 96 hours after the develop-
ment of complaints with the diagnosis or suspicion of AIM and discharged with the diagnosis of
a first/repeated AIM.
Early diagnosis of AIM was made in 1736 (55.6 %) patients. In the AUDIT study TLL was assessed
in 1074 (34.6 %) patients. A marked difference between the number of candidates for TLL and the
number of patients with TLL where TLL was implemented requires that in analyses of TLL in
patients with AIM attention should be paid also to reasons why it was not implemented. The most
frequent cause why TLL was nor implemented was late admission of the patient to hospital (in
patients who attended hospital < 6 hours, TLL was not implemented in 48.5 %, after admission
between 6 and 12 hours in 70 % and in patients admitted >12 hours in as many as 90.8 % patients),
equivocal indication of TLL (in 29.9 % patients) and contraindications (in 16.1 % patients). The
presented results are priority data on the early diagnosis of AIM and reasons why TLL was not
implemented. It is part of data essential needed for elaboration of a (national) programme of
better care (management) of patients with AIM taking into account also economic factors.
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