Prehospital thrombolysis for acute st-segment elevation myocardial infarction

Early treatment of acute ST elevation myocardial infarction is associated with a good prognosis and a low incidence of complications. Prehospital administration of thrombolytic treatment is one of the ways of starting treatment early after onset of symptoms. Fifteen years of experience in prehospital thrombolysis for acute ST elevation myocardial infarction has formed the basis of this thesis, together with data from another center, where prehospital triage and primary angioplasty is practised. Time to treatment results in a median time gain of 63 minutes, with twothirds of patients treated within two hours. Both mortality and the incidence of heart failure were significantly lower in the early treatment group compared to the group of patients treated later than that. Independent parameters of lower mortality were age, a shorter time to treatment, no hypertension and no prior infarction. Prehospital thrombolysis is associated with abortion of myocardial infarction (no rise in cardiac enzymes and subsiding ECG abnormalities within two hours after start of treatment). This fenomenon of abortion of myocardial infarction is also present in a patient population treated with primary angioplasty, after prehospital triage, especially if the treatment is started within two hours after the onset of symptoms. Newer bolus thrombolytics like reteplase are associated with a shorter time to treatment. The incidence of unjustified fibrinolysis in prehospital therapy, using two different ways of diagnosis, compares well with in-hospital false diagnosis. Prehospital thrombolysis is cost-effective: EUR 1,800 and EUR 2,800 per life year gained and compares well with other evidence-based therapies in myocardial infarctio