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Use of Thrombolytic Therapy for Acute Myocardial Infarction: Effects of Gender and Age on Treatment Rates

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Abstract

Background: Although there have been efforts to increase the utilization of thrombolytic therapy, there are still many patients who might benefit from this treatment who do not receive it. Women and the elderly have been particularly undertreated, despite evidence that their survival can be improved with thrombolysis. This study was undertaken to determine the relative rates of treatment of women vs. men and the elderly vs. younger subjects and to examine factors that might explain differences in treatment frequency.

Methods and Results: This is a retrospective study of patients who presented to the Emergency Departments of four local hospitals in 1993 and 1994 with evidence for acute ST-elevation myocardial infarction. Demographic data, past medical history, information on co-morbid illnesses, and times to hospital arrival, first electrocardiogram, physician notification, and thrombolytic therapy were recorded as was survival to hospital discharge. Data for patients who did or did not receive thrombolytic therapy were compared. Men were treated more frequently in both tertiary and community hospitals. Women were older, but within each age bracket, men were treated more often. The time of arrival was similar for men and women, but men who arrived within 6 hours or 6–12 hours after pain onset were treated at a higher rate than women. For patients without contraindications, treatment was not affected by gender or age. However, treatment rates decreased with increased prevalence of exclusionary factors, and since both women and the elderly tended to have more such factors, elderly women were treated at a markedly lower rate. The single clinical factor that increased thrombolytic usage in women compared to men was a history of prior myocardial infarction.

Conclusion: Despite convincing evidence that thrombolytic therapy is beneficial in women and the elderly, these groups have been relatively neglected unless attention is called to clinical risk, for example, by history of prior myocardial infarction.

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References

  1. European Secondary Prevention Study Group. Translation of clinical trials into practice: a European population-based study of the use of thrombolysis for acute myocardial infarction. Lancet 1996;347:1203–1207.

    Google Scholar 

  2. Chandra NC, Ziegelstein RC, Rogers WJ, et al., for the National Registry of Myocardial Infarction-1. Observations of the treatment of women in the United States with myocardial infarction: a report from the National Registry of Myocardial Infarction-1. Arch Int Med 1998;981–988.

  3. Barron HV, Bowlby LJ, Breen T, et al. Use of reperfusion therapy for acute myocardial infarction in the United States: data from the National Registry of Myocardial Infarction-2. Circulation 1998;97:115–1156.

    Google Scholar 

  4. Gan SC, Beaver SK, Houck PM, MacLehose MS, Lawson HW, Chan L. Treatment of acute myocardial ninfarction and 30-day mortality among women and men. New Engl J Med 2000;343:8–15.

    Google Scholar 

  5. Topol EJ, Califf RM. Thrombolytic therapy for elderly patients. N Engl J Med 1992;327:45–47.

    Google Scholar 

  6. Woodfield SL, Lundergan CF, Reiner JS, et al. Gender and acute myocardial infarction: is there a different response to thrombolysis? J Am Coll Cardiol 1997;29:35–42.

    Google Scholar 

  7. Brophy JM, Diodatin JG, Bogaty P, Theroux P. The delay to thrombolysis: an analysis of hospital and patient characteristics. CMAJ 1998;158:475–480.

    Google Scholar 

  8. Berger AK, Radford MJ, Krumholz HM. Factors associated with delay in reperfusion therapy in elderly patients with acute myocardial infarction: analysis of the Cooperative Cardivascular Project. Am Heart J 2000;139:985–992.

    Google Scholar 

  9. Rogers WJ, Canto JG, Barron HV, Boscarino JA, Shoultz DA, Every NR. Treatment and outcome of myocardial in-farction in hospitals with and without invasive capability. Investigators in the National Registry of Myocardial In-farction. J Am Coll Cardiol 2000;35:371–379.

    Google Scholar 

  10. Kudenchuk PJ, Maynard C, Martin JS, Wirkus M, Weaver WD for the MITI Project Investiogators. Comparison of presentation, treatment, and outcome of acute myocardial infarction in men versus women (The Myocardial Infarction Triage and Intervention Registry). Am J Cardiol 1996;78:9–14.

    Google Scholar 

  11. Adams JN, Jamieson M, Rawles JM, Trent RJ, Jennings KP. Women and myocardial infarction: agism rather than sexism? Br Heart J 1995;73:87–91.

    Google Scholar 

  12. Demirovic J, Blackburn H, McGovern PG, Luepker R, Sprafka M, Gilbertson D. Sex differences in early mortality after acute myocardial infarction (The Minnesota Heart Survey). Am J Cardiol 1995;75:1096–1101.

    Google Scholar 

  13. GISSI-Avoidable Delay Study Group. Epidemiology of avoidable delay in the care of patients with acute myocardial infarction in Italy. Arch Intern Med 1995;155:1481–1488.

    Google Scholar 

  14. Maynard C, Weaver WD, Lambrew C, Bowlby LJ, Rogers WJ, Rubison RM, for the participants in the National Registry of Myocardial Infarction. Factors influencing the time to administration of thrombolytic therapy with recombinant tissue plasminogen activator (Data from the National Registry of Myocardial Infarction). Am J Cardiol 1995;76:548–552.

    Google Scholar 

  15. Weaver WD, White HD, Wilcox RG, et al., for the GUSTO-1 Investigators. Comparisons of characteristics and outcomes among women and men with acute myocardial infarction treated with thrombolytic therapy. JAMA 1996;275:777–782.

    Google Scholar 

  16. Gurwitz JH, McLaughlin TJ, Willison DJ, et al. Delayed hospital presentation in patients who have had acute myocardial infarction. Ann Int Med 1997;126:593–599.

    Google Scholar 

  17. Newby LK, Rutsch WR, Califf RM, et al., for the GUSTO Investigators. Time from symptom onset to treatment and outcomes after thrombolytic therapy. J Am Coll Cardiol 1996;27:1646–1655.

    Google Scholar 

  18. Sharkey SW, Brunette DD, Ruiz E, et al. An analysis of time delays preceding thrombolysis for acute myocardial infarction. JAMA 1989;262:3171–3174.

    Google Scholar 

  19. Pfeffer MA, Moye LA, Braunwald E, et al. Selection bias in the use of thrombolytic therapy in acute myocardial infarction. The SAVE investigators. JAMA 1991;266:528–532.

    Google Scholar 

  20. Galcera-Tomas J, Melgarejo-Moreno A, Garcia-Alberola A, et al. Prognostic significance of diabetes in acute myocardial infarction. Are there differences linked to female gender? Int J Cardiol 1999;69:289–298.

    Google Scholar 

  21. Löwel H, Koenig W, Engel S, Hörmann A, Keil U. The impact of diabetes mellitus on survival after myocardial infarction: can it be modified by drug treatment? Results of a population-based myocardial infarction register follow-up study. Diabetologia 2000;43:218–226.

    Google Scholar 

  22. Weaver WD, Litwin PE, Martin JS, et al. The MITI Project Group. Effect of age on use of thrombolytic therapy and mortality in acute myocardial infarction. J Am Coll Cardiol 1991;18:657–662.

    Google Scholar 

  23. Ketley D, Woods KL, for the European Secondary Prevention Study Group. Selection factors for the use of thrombolytic treatment in acute myocardial infarction: a population based study of current practice in the United Kingdom. Br Heart J 1995;74:224–228.

    Google Scholar 

  24. McLaughlin TJ, Soumerai SB, Willison DJ, et al. Adherence to national guidelines for drug treatment of acute myocardial infarction: evidence for undertreatment in women and the elderly. Arch Int Med 1996;156:799–805.

    Google Scholar 

  25. Gurwitz JH, Gore JM, Goldberg RJ, Rubison M, Chandra N, Rogers WJ. Recent age-related trends in the use of thrombolytic therapy in patients who have had acute myocardial infarction. Ann Int Med 1996;124:283–291.

    Google Scholar 

  26. Boucher JM, Racine N, Thanh TH, et al., for the Quebec Acute Coronary Care Working Group. Age-related differences in in-hospital mortality and the use of thrombolytic therapy for acute myocardial infarction. CMAJ-JAMC 2001;164:1285–1290.

    Google Scholar 

  27. White HD. Thrombolytic therapy in the elderly. Lancet 2000;356:2028–2030.

    Google Scholar 

  28. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more that 1000 patients. Lancet 1994;343:311–322.

    Google Scholar 

  29. Berger AK, Radford MJ, Wang Y, Krumholz HM. Thrombolytic therapy in older patients. J Am Coll Cardiol 2000;36:366–374.

    Google Scholar 

  30. Thiemann DR, Coresh J, Schulman SP, Gerstenblith G, Oetgen WJ, Powe NR. Lack of benefit for intravenous thrombolysis in patients with myocardial infarction who are older than 75 years. Circulation 2000;101:2239–2246.

    Google Scholar 

  31. Thiemann DR, Schulman SP. Thrombolytics in elderly patients: a triumph of hope over experience? CMAJ-JAMC 2001;164:1301–1303.

    Google Scholar 

  32. White HD, Barbash GI, Modan M, et al., for the Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Study. After correction for worse baseline characteristics, women treated with thrombolytic therapy for acute myocardial infarction have the same mortality and morbidity as men except for a higher incidence of hemorrhagic stroke. Circulation 1993;88 (part 1):2097–2103.

    Google Scholar 

  33. White HD, Barbash GI, Califf RM, et al., for the GUSTO Investigators. Age and outcome with contemporary thrombolytic therapy. Results from the GUSTO-I trial. Circulation 1996;94:1826–1833.

    Google Scholar 

  34. Stone GW, Grines CL, Browne KF, et al. Comparison of in-hospital outcome in men versus women treated by either thrombolytic therapy or primary coronary angioplasty for acute myocardial infarction. Am J Cardiol 1995;75:987–992.

    Google Scholar 

  35. Sherry S, Marder VJ. Special Note. Mistaken guidelines for thrombolytic therapy of acute myocardial infarction in the elderly. J Am Coll Cardiol 1991;17:1237–1238.

    Google Scholar 

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Authors and Affiliations

  1. University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Karen L. Kaplan, Patricia Fitzpatrick, Christopher Cox, Nicolas W. Shammas & Victor J. Marder

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  1. Karen L. Kaplan
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  2. Patricia Fitzpatrick
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  4. Nicolas W. Shammas
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  5. Victor J. Marder
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Kaplan, K.L., Fitzpatrick, P., Cox, C. et al. Use of Thrombolytic Therapy for Acute Myocardial Infarction: Effects of Gender and Age on Treatment Rates. J Thromb Thrombolysis 13, 21–26 (2002). https://doi.org/10.1023/A:1015312007648

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