Rationale for pre-hospital thrombolysis

Early thrombolytic therapy in patients with acute myocardial infarction preserves left ventricular function and improves short- and long-term prognosis, as demonstrated in several trials. Unfortunately, most patients reach medical facilities more than 2 h into their infarction, and further time is lost in hospital before initiation of thrombolytic therapy. Thus, in the majority of patients with acute myocardial infarction the most critical period for effective therapy is missed. The delay between onset of cardiac symptoms suggestive of myocardial infarction and initiation of therapy has three components: (1) onset of symptoms, call for medical help; (2) travelling; (3) medical decision and start of treatment. Numerous studies show that it would be difficult to reduce the total time for onset of symptoms to call for medical help without an intensive media campaign. Recent observations documented the extraordinary delay in patient presentation and treatment in hospital. Thus, if the acute event could be diagnosed in the field and the team trained to initiate treatment immediately at home, time spent in travelling and in hospital will be significantly reduced. Therefore, the development of a plan of rapid intervention for diagnosis and treatment should become a major priority for all hospitals.