Should patients with suspected acute myocardial infarction receive thrombolytic therapy? A decision analytic model

To avoid unnecessarily exposing patients to the risks of thrombolytic therapy (TT), most clinical trials restrict TT to patients with symptoms suggestive of acute myocardial infarction (MI), with ST-segment elevation (STE) on the presenting ECG (electrocardiogram). Because not all patients with MI present with STE and because patients with fewer classic presentations may also benefit from TT, the authors have developed a simple decision analytic model to examine the effect of the probability of MI on the benefit and cost effectiveness of TT. The model suggests that the optimal ECG criteria for TT administration should be more sensitive and less specific than the currently used STE criterion