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Early intravenous thrombolysis in acute myocardial infarction: the Jerusalem experience
Y Rozenman1, M S Gotsman, A T Weiss
1Department of Cardiology, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel.
Insights
Prehospital thrombolytic therapy for acute myocardial infarction is safe and feasible. Early treatment at home reduces ischemia duration and improves left ventricular function compared to hospital administration, without increasing complications.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Background:
- Acute myocardial infarction (AMI) involves time-dependent myocardial damage.
- Early intervention is crucial for preserving left ventricular function and reducing mortality.
- Comparing prehospital versus in-hospital thrombolytic administration is key to optimizing treatment timing.
Purpose of the Study:
- To evaluate the impact of very early thrombolytic therapy on mortality, complications, and left ventricular function in AMI patients.
- To compare the outcomes of prehospital thrombolytic administration versus in-hospital administration.
- To assess the feasibility and safety of prehospital thrombolytic therapy.
Main Methods:
- A cohort of 760 patients with AMI received early thrombolytic therapy.
- Patients were divided into two groups: prehospital (home) administration (n=114) and in-hospital administration (n=646).
- Outcomes assessed included in-hospital mortality, complications (hemorrhage), duration of ischemia (pain, ST-segment recovery), peak creatine kinase levels, and left ventricular function (ejection fraction, dysfunction index) via contrast ventriculography.
Main Results:
- Prehospital therapy group had a shorter time delay to treatment (1.4h vs. 2.1h) and reduced duration of ischemia (pain, ST-segment recovery).
- No significant differences were observed in in-hospital mortality or complication rates between groups.
- Patients receiving prehospital therapy demonstrated better left ventricular function (higher ejection fraction, lower dysfunction index) one week post-admission.
Conclusions:
- Prehospital thrombolytic therapy for AMI is feasible and safe.
- This strategy leads to earlier reperfusion and improved myocardial salvage.
- Prehospital administration offers better preservation of left ventricular function without an increased risk of complications.
Abstract:
Myocardial damage in acute myocardial infarction is a time-dependent process. We examined the influence of very early thrombolytic therapy, comparing prehospital to hospital administration, in a consecutive group of patients with myocardial infarction on mortality, complications and the preservation of left ventricular function. Seven hundred sixty patients received early thrombolytic therapy: 114 at home (time delay to treatment 1.4 +/- 0.8 h) and 646 in hospital (2.1 +/- 1.0 h). Sixteen patients died in hospital and significant hemorrhage occurred in 15 (including three patients with hemorrhagic stroke). There was no difference between groups in hospital mortality or rate of complications. The duration of ischemia was shorter in patients with prehospital therapy (pain duration: 3.3 +/- 2.1 vs. 4.0 +/- 2.2; P < 0.05, and time to recovery of the ST segment in the electrocardiogram: 4.3 +/- 3.3 vs. 6.6 +/- 6.3; P < 0.002). Peak plasma creatine kinase was earlier in patients with prehospital therapy (11.2 +/- 5.0 vs. 13.0 +/- 5.8; P < 0.002), although there was no difference between groups in the absolute peak plasma level. Left ventricular function was assessed by contrast ventriculography 1 week after admission (616 patients). Ventricular function was better in patients with prehospital therapy: (ejection fraction of 58 +/- 13% vs. 54 +/- 15%; P < 0.05 and a left ventricular dysfunction index of 534 +/- 515 vs. 691 +/- 519 units; P < 0.05). We conclude that prehospital thrombolytic therapy is feasible and safe. Reperfusion is achieved earlier and more myocardium can be salvaged using this strategy without increasing the rate of complications.