Thrombolytic therapy use for acute myocardial infarction and outcome in Qatar

Abstract

Objective Data on the outcome of patients treated with thrombolytic therapy in the Arab world is scarce. The main objective of this study is to study the 7-day morbidity and mortality rate and the rate of use of thrombolytic therapy in patients presenting with acute myocardial infarction treated with thrombolytic therapy in the Middle East. Methods We conducted a retrospective analysis of prospectively collected data for all patients who were admitted to Coronary Care Unit in Cardiology Department in Hamad Medical during the period (1991–2001). Patients were divided into two groups in relation to ethnicity whether they received thrombolysis or not. In each group, the number of patients, age at the time of admission, gender, cardiovascular risk profile, therapy and outcome in regard of in-hospital complication and 7-day death as primary end point were analyzed. Results Of the total 5388 patients admitted with acute myocardial infarction during the 10-year period, 66.3% (3567) with STE MI were found, 61.4% (2190) of them received thrombolytic therapy while 38.6% (1377) were not eligible for thrombolytic therapy. The remaining 33.7% (1821) were admitted with non-STE MI. In consideration of ethnic variation, patients with STE MI eligible for thrombolytic therapy, 29.6% (1598) were Qataris and 70.4% (3792) were non-Qataris. Thrombolytic therapy was administered to 25.9% (414) of Qatari patients and 51.3% (1947) of non-Qataris. The mortality rate of Qatari patients who received thrombolytic therapy was 9.2% (38) vs. 19.5% (231) who did not receive thrombolytic therapy ( p<0.001). In non-Qatari patients, the mortality rate was 5.2% (102) for those who received thrombolytic therapy, while it was 8.6% (159) for those with no thrombolytic therapy ( p<0.001). When compared to male patients, female patients with thrombolytic therapy had higher mortality rates (in both Qataris and non-Qataris) (20.5% vs. 6.1%; p value<0.001 and 16.1% vs. 9.4%; p<0.001, respectively), there were no significant differences between the ethnic groups in regard to in-hospital complications. Patients treated with thrombolytic therapy had lower incidence of in-hospital complication regarding acute heart failure, post-myocardial angina, heart block and arrhythmia. Thrombolytic therapy reduced mortality rate in acute myocardial infarction by 69%. Logistic regression analysis had shown that arrhythmia, acute heart failure, heart block, cardiogenic shock, diabetes mellitus and stroke were independent predictors of increased mortality. Thrombolysis was used in 61.4%, which is still underutilized when compared to a few available studies in the Gulf area, and to other studies in the developed world. Conclusion In the current study, use of thrombolysis in acute myocardial infarction was associated with significant decrease in in-hospital mortality and morbidity. Mortality rate was higher in the Qatari nationals when compared to non-Qataris. Reperfusion therapy may be underutilized in the developing world. Increased use of reperfusion therapy would result in reduced mortality rate. Global measures to encourage the use of reperfusion therapy including patients' education, and strategies to improve the health care system are needed.