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European Heart Journal 1995 16(1):1833-1838;
Copyright © 1995 by the European Society of Cardiology.
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© 1995 The European Society of Cardiology

Pre-hospital thrombolytic therapy with either alteplase or streptokinase

Practical applications, complications and long-term results in 529 patients

E. W. M. GRIJSEELS*,{dagger}, M. J. M. BOUTEN{ddagger}, T. LENDERINK*, J. W. DECKERS*, A. W. HOES{dagger},§, J. A. M. HARTMAN{ddagger}, E. VAN DER DOES{dagger} and M. L. SIMOONS*,

*Thoraxcentre, Department of Cardiology, Erasmus University Rotterdam The Netherlands
{dagger}Department of General Practice, Erasmus University Rotterdam The Netherlands
{ddagger}Ambulance service, Municipal Health Department Rotterdam The Netherlands
§Department of Epidemiology and Biostatistics, Erasmus University Rotterdam The Netherlands

revised 7 April 1995; accepted 26 April 1995.

Correspondence: Prof. M. L. Simoons, University Hospital Rotterdam, room Bd 434, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

Abstract

OBJECTIVE: To assess the practical application, safety and long-term outcome of pre-hospital thrombolytic intervention with either alteplase or streptokinase in patients with extensive myocardial infarction.

DESIGN: Prospective study.

SUBJECTS: Patients with chest pain of more than 30 min duration, presenting within 6 h of symptom onset and with electrocardiographic evidence of extensive evolving myocardial infarction.

METHODS: Eligibility of patients was established by the general practitioner or the ambulance nurse using a standardized questionnaire with (contra-) indications for thrombolytic therapy. Computerized ECG was recorded by ambulance nurses. In the presence of extensive ST segment elevation (sum ST deviation of at least 1·0 m V), eligible patients received either 100 mg alteplase (n=246) or 50 mg alteplase in the ambulance followed by 0·75 x 106 IE streptokinase in hospital (n=90), or 1·5 x 106 IE streptokinase intravenously (n=193).

MAIN OUTCOME MEASUREMENTS: Death and life-threatening complications (ventricular fibrillation, cardiac arrest) and side effects (hypotension, allergic reactions) during transportation to hospital and in the first 24 h following hospitalization, and survival up to 5 years follow-up.

RESULTS: From 1988–1993, 529 patients received thrombolytic treatment initiated pre-hospital. The time gained by pre-hospital administration of thrombolysis amounted to 50 min. The rate of complications during transportation and during the first 24 h after hospitalization was low. Hospital mortality was 2% and 1-year mortality 3%. Cumulative survival at 5 years was 92%. This was superior to the 84% 5-year survival observed in a matched group of 239 patients with similar baseline characteristics treated with alteplase in hospital.

CONCLUSIONS: Pre-hospital administration of either alteplase or streptokinase is feasible and safe and results in significant time gain. The long-term prognosis is excellent in spite of extensive evolving myocardial infarction upon admission.

Key Words: Myocardial infarction • thrombolysis • long-term results


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