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European Heart Journal Advance Access originally published online on April 19, 2006
European Heart Journal 2006 27(10):1146-1152; doi:10.1093/eurheartj/ehi886
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Pre-hospital thrombolysis delivered by paramedics is associated with reduced time delay and mortality in ambulance-transported real-life patients with ST-elevation myocardial infarction

Erik Björklund1,*, Ulf Stenestrand2, Johan Lindbäck3, Leif Svensson4, Lars Wallentin3, Bertil Lindahl1 on behalf of the RIKS-HIA Investigators

1 Department of Cardiology, University Hospital of Uppsala, 751 85 Uppsala Sweden
2 Department of Cardiology, University Hospital of Linköping, Stockholm Sweden
3 Uppsala Clinical Research Center, University Hospital of Uppsala, Uppsala Sweden
4 Department of Cardiology, South Hospital, Stockholm Sweden

Received 27 September 2005; revised 3 March 2006; accepted 23 March 2006; online publish-ahead-of-print 19 April 2006.

* Corresponding author. Tel: +46 18 6114043; fax: +46 18 506638. E-mail address: erik.bjorklund{at}akademiska.se

See page 1131 for the editorial comment on this article (doi:10.1093/eurheartj/ehi740)

Aims There are sparse data on the impact of pre-hospital thrombolysis (PHT) in real-life patients. We therefore evaluated treatment delays and outcome in a large cohort of ambulance-transported real-life patients with ST-elevation myocardial infarction (STEMI) according to PHT delivered by paramedics or in-hospital thrombolysis.

Methods and results Prospective cohort study used data from the Swedish Register of Cardiac intensive care on patients admitted to the coronary care units of 75 Swedish hospitals in 2001–2004. Ambulance-transported thrombolytic-treated patients younger than age 80 with a diagnosis of acute myocardial infarction were included. Patients with PHT (n=1690) were younger, had a lower prevalence of co-morbid conditions, fewer complications, and a higher ejection fraction (EF) than in-hospital-treated patients (n=3685). Median time from symptom onset to treatment was 113 min for PHT and 165 min for in-hospital thrombolysis. One-year mortality was 7.2 vs. 11.8% for PHT and in-hospital thrombolysis, respectively. In a multivariable analysis, after adjusting for baseline characteristics and rescue angioplasty, PHT was associated with lower 1-year mortality (odds ratio 0.71, 0.55–0.92, P=0.008).

Conclusion When compared with regular in-hospital thrombolysis, pre-hospital diagnosis and thrombolysis with trained paramedics in the ambulances are associated with reduced time to thrombolysis by almost 1 h and reduced adjusted 1-year mortality by 30% in real-life STEMI patients.

Key Words: Acute myocardial infarction • Pre-hospital thrombolysis • Treatment delay • Mortality


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