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Medical management of acute myocardial infarction in Ireland: Information from the second international study of infarct survival (ISIS - 2)

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Abstract

We report the management of the 831 patients from 18 hospitals which constituted the Irish component of the 17,183 subjects enrolled in the ISIS-2 trial which studied the effects of streptokinase infusion and aspirin therapy given to patients presenting within 24 hours of the onset of suspected acute myocardial infarction.

34% of Irish patients (IP) presented for treatment within 4 hours of the development of symptoms. This compared to 44% of the overall group (OG) (p<0.001). This represented the lowest percentage of patients presenting within 4 hours in any of the participating countries. The mean delay time from onset of symptoms was 7.9 hours in IP compared to 6.9 in OG (p<0.001). The mean delay time in Ireland was longer than the mean delay time in any of the participating countries. The mean age and systolic blood pressure at presentation was similar in both groups.

It was planned to treat 12% IP with aspirin compared to 10% OG (p-NS), and 71% IP with subcutaneous heparin compared with 47 % OG (p<0.001). Intravenous heparin was planned treatment in 20% IP and 24% OG (p<0.01). Planned oral anticoagulant therapy was similar in both groups (p-NS). Planned use of intravenous betablockers occurred in only 2% IP and 6% OG (p<0.001).

9% IP and 22% OG received steroids before streptokinase infusion (p<0.001). 65% IP and 47% OG received subcutaneous heparin (p<0.001). The use of intravenous heparin and oral anticoagulants was similar in IP and OG (p-NS). Only 1% IP received intravenous betablocker therapy versus 5% OG (p<0.001).

6% IP and 11% OG were discharged on oral anticoagulants (p<0.001). There was similar use of nontrial aspirin in both groups (p-NS). 16 % IP were discharged on betablocker therapy compared to 32% OG (p<0.001).

In conclusion IP were similar to OG in baseline characteristics. IP presented later for therapy, received more subcutaneous heparin, and less intravenous steroids before streptokinase infusion. Less IP received oral betablockade on discharge.

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Authors and Affiliations

  1. Department of Cardiology, Beaumont Hospital, Dublin 9

    G. A. MacGowan, D. O’Callaghan & J. H. Horgan

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  1. G. A. MacGowan
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  2. D. O’Callaghan
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  3. J. H. Horgan
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The ISIS - 2 Irish Collaborators

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MacGowan, G.A., O’Callaghan, D., Horgan, J.H. et al. Medical management of acute myocardial infarction in Ireland: Information from the second international study of infarct survival (ISIS - 2). I.J.M.S. 160, 347–349 (1991). https://doi.org/10.1007/BF02957892

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