Thrombolytic therapy: impact on coronary care in a district general hospital.

The introduction of routine thrombolytic therapy in the Cardiac Care Unit (CCU) of a District General Hospital has resulted in an increased demand for admission particularly in the 70+ age group. Complications and side effects of such treatment have been similar to those reported in several large multicentre trials. The percentage of patients with myocardial infarction receiving thrombolysis has increased to 60% with the commonest reason for withholding of such treatment being the lack of ECG changes. Mortality rates have fallen and there has been an increased referral rate for urgent angiography. To maximise benefit CCU's should encourage early direct admission and ensure that, if not present on site, facilities for angiography can easily be arranged.