BACKGROUND/ OBJECTIVES: The purpose of this observational study was to provide an impression of the outcomes of prehospital thrombolysis in combination with an active coronary angioplasty intervention (PCI) strategy for acute ST-elevation myocardial infarction. METHODS: In a group of 151 consecutive patients the following parameters were measured: time delay, percentage of reperfusion, reocclusion, stroke, death, need for PCI and the number of protocol violations. RESULTS: The diagnosis by the ambulance paramedics was made in 8±6 minutes, followed by thrombolysis in 13±7 minutes (median±SD). In 2% (3) of the patients the thrombolytic agent was erroneously administered without complications. The elapsed time from onset of symptoms to treatment was a median of 112±77 minutes. Five percent (7) of the patients died in the first 30 days and 2% (3) suffered an intracerebral haemorrhage. Reperfusion was documented in 76% (112) of the patients, from which 18% (20) reoccluded in the following 24 hours. In patients where reperfusion was not established or reocclusion occurred, patients underwent rescue/facilitated PCI: in total 37% (55 patients). After three months 9% (13) of the patients had severly impaired (EF <40%) left ventricular function. CONCLUSION: In our region, we successfully implemented the prehospital thrombolysis system achieving a competitive call-to-needle time and reperfusion rate. The percentage of patients who violated the protocol, suffered an intracerebral haemorrhage, died and/or had severely impaired left ventricular function was acceptable.
BACKGROUND/ OBJECTIVES: The purpose of this observational study was to provide an impression of the outcomes of prehospital thrombolysis in combination with an active coronary angioplasty intervention (PCI) strategy for acute ST-elevation myocardial infarction. METHODS: In a group of 151 consecutive patients the following parameters were measured: time delay, percentage of reperfusion, reocclusion, stroke, death, need for PCI and the number of protocol violations. RESULTS: The diagnosis by the ambulance paramedics was made in 8±6 minutes, followed by thrombolysis in 13±7 minutes (median±SD). In 2% (3) of the patients the thrombolytic agent was erroneously administered without complications. The elapsed time from onset of symptoms to treatment was a median of 112±77 minutes. Five percent (7) of the patients died in the first 30 days and 2% (3) suffered an intracerebral haemorrhage. Reperfusion was documented in 76% (112) of the patients, from which 18% (20) reoccluded in the following 24 hours. In patients where reperfusion was not established or reocclusion occurred, patients underwent rescue/facilitated PCI: in total 37% (55 patients). After three months 9% (13) of the patients had severly impaired (EF <40%) left ventricular function. CONCLUSION: In our region, we successfully implemented the prehospital thrombolysis system achieving a competitive call-to-needle time and reperfusion rate. The percentage of patients who violated the protocol, suffered an intracerebral haemorrhage, died and/or had severely impaired left ventricular function was acceptable.
Entities:
Keywords:
active rescue PCI strategy; acute myocardial infarction; facilitated PCI; paramedics; prehospital thrombolysis; rural community
Authors: Henning R Andersen; Torsten T Nielsen; Klaus Rasmussen; Leif Thuesen; Henning Kelbaek; Per Thayssen; Ulrik Abildgaard; Flemming Pedersen; Jan K Madsen; Peer Grande; Anton B Villadsen; Lars R Krusell; Torben Haghfelt; Preben Lomholt; Steen E Husted; Else Vigholt; Henrik K Kjaergard; Leif Spange Mortensen Journal: N Engl J Med Date: 2003-08-21 Impact factor: 91.245
Authors: Bruno Scheller; Benno Hennen; Bernd Hammer; Jürgen Walle; Christian Hofer; Volker Hilpert; Horst Winter; Georg Nickenig; Michael Böhm Journal: J Am Coll Cardiol Date: 2003-08-20 Impact factor: 24.094
Authors: P Widimský; T Budesínský; D Vorác; L Groch; M Zelízko; M Aschermann; M Branny; J St'ásek; P Formánek Journal: Eur Heart J Date: 2003-01 Impact factor: 29.983