Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Prehospital thrombolysis with alteplase (rt-PA) in acute myocardial infarction
*Thoraxcenter, Erasmus University and University Hospital Rotterdam ‘Dijkzigt’ The Netherlands
Municipal Health Service Rotterdam, Ambulance Department The Netherlands
Center for Clinical Decision Analysis, Erasmus University Rotterdama The Netherlands
Institute for General Practice, Erasmus University Rotterdam The Netherlands
Received 4 June 1991; revised 6 January 1992; .
Correspondence: M. J. M. Bouten, Ambulancedienst GGD K 51, Schiedamsedijk 95, 3011 EN Rotterdam, The Netherlands.
Abstract
The improvement in survival in patients undergoing thrombolytic therapy in myocardial infarction is determined by the delay between coronary occlusion and reperfusion. The REPerfusion in Acute Infarction Rotterdam (REPAIR) study was designed to examine the feasibility and safety of prehospital thrombolysis with alteplase (rt-PA, ‘Actilyse’). A small portable ECG computer system is used to confirm the presence of a large myocardial infarction (at least I.OmV ST-deviation) ‘on the spot’.
Between 22 June 1988 and I January 1991, 226 patients were treated by the ambulance service after the evaluation of 9052 patients complaining of chest pain. Therapy could be initiated within an average of 100± 56 min (SD) after the onset of symptoms, and within 22±9 min after ambulance arrival. Three patients were defibrillated during transportation. Six patients (3%) died after arrival in the hospital. The time gained by prehospital treatment was 47 min (95% confidence limits 44–51 min) in comparison with 220 patients who did not meet the criteria for prehospital thrombolysis, but received thrombolytic therapy as soon as possible after hospital admission.
The developed procedure allows rapid and safe initiation of thrombolytic therapy in selected patients, even in the absence of a physician. The observed low mortality supports the concept that prehospital thrombolytic therapy is indeed beneficial to the patient.
Key Words: Prehospital thrombolysis • alteplase • computerized ECG-analysis
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  Part 5: Acute Coronary Syndromes Circulation, November 29, 2005; 112(22_suppl): III-55 - III-72. [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. Terkelsen, J. F. Lassen, B. L. Norgaard, J. C. Gerdes, S. H. Poulsen, K. Bendix, J. P. Ankersen, L. B.-H. Gotzsche, F. K. Romer, T. T. Nielsen, et al. Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutanous coronary intervention Eur. Heart J., April 2, 2005; 26(8): 770 - 777. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kroese, D. Kanka, P. Weissberg, B. Arch, and J. Scott Prehospital thrombolysis--calculated health benefit for catchment population of one hospital J R Soc Med, May 1, 2004; 97(5): 230 - 234. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Task Force on the Management of Acute Myocardi, F. Van de Werf, D. Ardissino, A. Betriu, D. V. Cokkinos, E. Falk, K. A.A. Fox, D. Julian, M. Lengyel, F.-J. Neumann, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation Eur. Heart J., January 1, 2003; 24(1): 28 - 66. [Full Text] [PDF]
|
|
|
|
 |
|
 E BOERSMA Acute myocardial infarction: bring the treatment to the patient Heart, October 1, 1999; 82(4): 404 - 404. [Full Text] [PDF]
|
|
|
|
 |
|
 C F M Weston, W J Penny, and D G Julian Guidelines for the early management of patients with myocardial infarction BMJ, March 19, 1994; 308(6931): 767 - 771. [Full Text]
|
|