Prehospital thrombolysis in acute myocardial infarction

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Abstract

The benefit and risk of prehospital thrombolysis for acute myocardial infarction (AMI) were evaluated in a double-blind randomized trial. Patients presenting < 4 hours after symptom onset received 2 million units of urokinase as an intravenous bolus either before (group A, n = 40) or after (group B, n = 38) hospital admission. The mean time interval from onset of symptoms to thrombolytic therapy was 85 ± 51 minutes in group A and 137 ± 50 minutes in group B (p < 0.0005). In 91% of the patients, thrombolytic therapy was administered < 3 hours after symptom onset. Complication rates during the pre- and in-hospital perlod were low and did not differ between groups. Three patients died (1 in group A, 2 in group B) from reinfarction 7 to 14 days after admission. Left-sided cardiac catheterization before discharge revealed a patency rate in the infarct-related artery of 61% in group A and 67% in group B (difference not significant). Global left ventricular function and regional wall motion at the infarct site did not differ significantly between group A and B (ejection fraction 51 ± 10%, n = 28 vs 53 ± 14%, n = 28; wall motion −2.3 ± 1.3 vs −2.2 ± 1.1 standard deviation, respectively). Also, peak creatine kinase did not differ significantly (838 ± 634 U/liter in group A vs 924 ± 595 U/liter in group B). Prehospital thrombolysis using a bolus injection of urokinase has a low risk when performed by a trained physician with a mobile care unit. The saving of 45 minutes in the early stage of an acute infarction through prehospital thrombolysis did not appear to be important for salvage of myocardial function.

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