Freqüência de utilização e razoes de exclusão da terapia trombolítica no infarto agudo do miocárdio em Salvador-Bahia / Frequency of utilization and reasons for exclusion from thrombolytic therapy in patients with acute myocardial infarction in Salvador-Bahia

RESUMO

PURPOSE: To determine the rate of utilization and reasons for exclusion from thrombolytic therapy in acute myocardial infarction (AMI) in the setting of Intensive Care Unit (ICU) Salvador-BA. METHODS: Retrospective cohort study recording patients admitted with suspected AMI in six ICU in Salvador-BA between January/93 and December/94 were reviewed. RESULTS: Three hundred and eighty-eight of confirmed cases of AMI were analysed, 165 (42.0) were admitted at public hospitals and 225 (58.0) at private hospitals. Thrombolytic therapy was indicated in 143 (36.8) patients. The thrombolysis was more frequently performed in men (PR = 1.96 IC 95 1.39-2.77), in patients less than 60 years of age (PR = 4.46 CI 95 2.17-9.19) and in those with Killip class I (PR = 2.62 CI 95 1.60-4.31). The major reasons for excluding from thrombolytic therapy were late arrival, old age and lack of ST elevation. Thirty three percent of patients were excluded for more than one reasons. Multivariate analysis showed that female gender was associated with a reduced indication for thrombolytic therapy, independent of the clinical findings on admission. CONCLUSION: The frequency of the use and reasons for excluding patients from thrombolytic therapy in AMI in Salvador-BA were similar to those of other clinical studies. The recent recommendations of the Thrombolysis Brazilian Consensus will enhance the utilization of this therapy, as it expands its utilization to elderly patients and to those who arrive late to the hospital.