Prehospital thrombolysis in acute myocardial infarction

Efficacy of reperfusion therapy in acute myocardial infarction (AMI) is strictly time-dependent. Most benefit is achieved with initiation of therapy within the first 60-90 min after onset of symptoms. The majority of patients with AMIs are seen within this time window by emergency medical services. Moreover, average time gain of about 60 min is possible by prehospital thrombolysis. Randomized studies yielded a better outcome when a time gain of 90 min and more was achieved. Prehospital diagnosis of AMI is reliable. Moreover, out-of-hospital thrombolysis has no additional specific risks nor is it an obstacle for later percutaneous intervention. Consequently, patients seen within the first 60-90 min after onset of symptoms or for whom a time gain of 90 min or more can be expected should receive immediate prehospital thrombolysis.