[Fibrinolysis in acute myocardial infarct. Treatment rate, assessment and follow-up treatment in the Zürich hospitals].

We report the results of i.v. fibrinolysis in patients with acute myocardial infarction treated in four major hospitals in Zürich. Between 1986 and 1988 only 96 (9%) of 1069 patients admitted to intensive care units with acute myocardial infarction received thrombolytic therapy (less than 3 hours after onset of symptoms), 7% (50/703) during the first treatment period (streptokinase for 14 months), 13% (46/306) during the second treatment period (rt-PA for 8 months). The hospital mortality was 4% and severe complications of fibrinolytic therapy occurred in 4%. Coronary angiography was performed in 60% of patients in 1986/87 and in 87% in 1987/88. Despite this significant increase in invasive diagnostic procedures the percentage of patients after thrombolysis qualifying for invasive therapy remained unchanged at 53%. The indications for PTCA or bypass surgery were postinfarct angina in 41%, silent ischemia in 5%, left main coronary artery stenosis or multivessel disease with reduced left ventricular ejection fraction in 16%, and residual high grade stenosis with preserved contractility of the infarct-related myocardium in 38%. The mean in-hospital stay was 16 days, with significant variation from 13 to 22 days between the different hospitals (p less than 0.05). In the follow-up of 65 men aged below 65 years, 75% of the patients undergoing invasive therapy and 65% of those treated medically had returned to work 6 months after myocardial infarction. Due to the limited possibility of detecting viable myocardium by non-invasive methods, and the high rate of invasive therapy necessary in our patients, further management after thrombolysis should generally include large scale coronary angiography.(ABSTRACT TRUNCATED AT 250 WORDS)