Dodek: Treating acute myocardial infarction [CMAJ

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Treating acute myocardial infarction

CMAJ 2001;164(3):324 [PDF]

In response to: D. Kollek

Daniel Kollek has made a good point in that most patients with acute myocardial infarction are seen initially by emergency physicians. In most cases, emergency physicians now commence thrombolytic therapy. The increased use of thrombolytic agents has been associated with reduced mortality and improved outcomes in the treatment of patients with acute myocardial infarction.¹

However, there are additional factors that may contribute to reductions in in-hospital mortality as well to reductions in mortality following hospital discharge: increased use of medications such as ß-blockers, angiotensin-converting-enzyme inhibitors and lipid-lowering agents; [Research]² and increased use of angiography and revascularization procedures.³

Although "primary coronary angioplasty may be the optimal treatment of acute myocardial infarction," [Commentary]³ it is available in only 10% of hospitals and therefore we must rely on prompt treatment with thrombolysis, which is delivered diligently by Kollek and other emergency room physicians.⁴ This pattern of practice has improved patients' outcomes.

Arthur Dodek
Clinical Professor of Medicine
University of British Columbia
Vancouver, BC

References

    1.    ISIS-3 (Third International Study of Infarct Survival Collaborative Group). ISIS-3: a randomized comparison of streptokinase vs. tissue plasminogen activator vs. antistreplase and of aspirin plus heparin vs. aspirin alone among 41 299 cases of suspected acute myocardial infarction. Lancet 1992;339:753-70. [MEDLINE]

    2.    Pilote L, Lavoie F, Ho V, Eisenberg MJ. Changes in the treatment and outcomes of acute myocardial infarction in Quebec, 1988–1995. CMAJ 2000;163(1):31-6.

    3.    Dodek A. Acute myocardial infarction in Canada: improvement with time [commentary]. CMAJ 2000;163(1):41-2.

    4.    Lee TH, Weisberg MC, Brand DA, Rouan GW, Goldman L. Candidates for thrombolysis among emergency room patients with acute chest pain. Ann Intern Med 1989;110:957-62. [MEDLINE]