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European Heart Journal Advance Access published online on October 23, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn462
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Pre-hospital thrombolysis in perspective

Nicolas Danchin*, Eric Durand and Didier Blanchard

Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris and Université Paris 5 René Descartes, Paris, France

Received 21 November 2007; revised 23 September 2008; accepted 29 September 2008.

* Corresponding author: Division of Coronary Artery Disease and Intensive Care, HEGP, 20 rue Leblanc, 75015 Paris, France. Tel: +33 156 09 25 71, Fax: +33 156 09 25 72, Email: nicolas.danchin{at}egp.aphp.fr

Aims: To review existing evidence on the role of pre-hospital fibrinolysis in patients with ST-elevation myocardial infarction (MI).

Methods and results: Overview of current guidelines and data from trials and registries on the best perfusion approach for acute MI with ST-elevation. Despite advances in the treatment of ST-elevation MI, the mortality rate before any therapy is administered is high, with half of all fatalities occurring within 2 h of symptom onset. Current treatment options, including the timely use of pre-hospital fibrinolysis, have reduced the overall 1 month mortality. Mortality can be further improved when patient characteristics, risk factors and time delays to treatment are considered.

Conclusion: Time factors are essential in the success of fibrinolysis, and subsequent coronary intervention seems beneficial.

Key Words: Pre-hospital thrombolysis • ST-elevation myocardial infarction • Primary PCI • Registry • Randomized trial


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