This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

A Critical Analysis of Therapy in the Community Setting

William W. Rowe, MD; Ross J. Simpson, Jr, MD; David A. Tate, MD; Park W. Willis IV, MD; Timothy C. Nichols, MD; Jack W. Noneman, MD; Leonard S. Gettes, MD

Arch Intern Med. 1989;149(7):1611-1617.

Abstract
• We evaluated a strategy for administering thrombolytic therapy without emergent cardiac catheterization to patients with acute myocardial infarction in community hospitals. Fifty-nine patients were treated with intravenous streptokinase and heparin, and referred for elective catheterization. Angioplasty or bypass surgery was performed only in patients judged to be at risk for reinfarction. One or more predetermined criteria for infarct segment viability were present in 47(80%) of 59 patients. Angina recurred in 24 patients and enzyme-positive reinfarction in 9 patients, but only 2 patients developed new Q waves or a creatine kinase rise to over twice the normal value. Of 18 patients judged to be at low risk for reinfarction, only 1 required urgent angioplasty or bypass surgery. Fourteen-day mortality was 7% and infarct vessel patency was 94%. These data indicate that physicians in small community hospitals with a close relationship to a referral center and with a carefully designed protocol can administer thrombolytic therapy safely and effectively. By subsequent stratification of patients according to the risk of recurrent infarction, 22% of patients eligible for revascularization were spared urgent angioplasty or bypass surgery.

(Arch Intern Med. 1989;149:1611-1617)

Author Affiliations
the University of North Carolina Cardiology Consortium

From the Division of Cardiology, School of Medicine, University of North Carolina at Chapel Hill.

Footnotes
Accepted for publication March 4,1989.

Reprint requests to Division of Cardiology, Box 7075, Burnett-Womack Bldg, University of North Carolina, Chapel Hill, NC 27599 (Dr Gettes).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Treatment of Acute Myocardial Infarction
Beauchamp et al.
NEJM 1993;329:430-433.
FULL TEXT  

Comparison of Coronary Angiographic Features and Oral Dipyridamole Thallium 201 Tomography
Jain et al.
ANGIOLOGY 1991;42:99-105.
ABSTRACT