Use of thrombolytic agents and other drugs in acute myocardial infarction

Data on all patients with acute myocardial infarction who were treated in the ten hospitals in Health region 1 in Norway were extensively analysed over a two month period. Of all the 487 patients 32% received thrombolytic treatment; i.e 36% of those with definite or suspected myocardial infarction on admission. Thrombolytics were withheld, mainly because only 58% of the patients showed ST elevation or bundle branch block on their ECG, and because of a long delay from onset of symptoms to admission to hospital. With increasing age use of thrombolytics decreased, and high age seemed to some degree to act as a contraindication. Relative contraindications such as history of stroke or peptic ulcer contributed modestly to the limited use of thrombolytics. Aspirin was used by 72% of the patients, and either aspirin or anticoagulants in 87%. At six month follow-up 50% used aspirin and 32% warfarin. Betablockers were given to 57% of the patients in hospital, but were not used to any extent in the acute phase of the disease; at six months the proportion of patients on betablockers was about the same. Oral nitrates were used more extensively than betablockers and there is a clear indication that angiotensin converting enzyme inhibitors are used increasingly for secondary prevention.