European Heart Journal Advance Access published online on April 19, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi886
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1 Department of Cardiology, University Hospital of Uppsala, 751 85 Uppsala, Sweden
* To whom correspondence should be addressed. 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.
Received September 27, 2005
Revised March 3, 2006
Accepted March 23, 2006
Clinical research
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 Björklund 1 *,
Ulf Stenestrand 2,
Johan Lindbäck 3,
Leif Svensson 4,
Lars Wallentin 3,
Bertil Lindahl,
and
on behalf of the RIKS-HIA Investigators 1
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
Erik Björklund, E-mail: erik.bjorklund{at}akademiska.se
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