Morrow David A, Antman Elliott M, Sayah Assaad, Schuhwerk Kristin C, Giugliano Robert P, deLemos James A, Waller Michael, Cohen Sidney A, Rosenberg Donald G, Cutler Sally S, McCabe Carolyn H, Walls Ron M, Braunwald Eugene
Cardiovascular Division and TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
J Am Coll Cardiol. 2002 Jul 3;40(1):71-7. doi: 10.1016/s0735-1097(02)01936-8.
The Early Retavase-Thrombolysis In Myocardial Infarction (ER-TIMI) 19 trial tested the feasibility of prehospital initiation of the bolus fibrinolytic reteplase (rPA) and determined the time saved by prehospital rPA in the setting of contemporary emergency cardiac care.
Newer bolus fibrinolytics have undergone only limited evaluation for prehospital administration. In addition, as door-to-drug times have decreased, the relevance of findings from prior trials of prehospital fibrinolysis has become less certain.
Patients (n = 315) with ST-elevation myocardial infarction (STEMI) were enrolled in 20 emergency medical systems in North America. The time from emergency medical service (EMS) arrival to administration of a fibrinolytic was compared between study patients receiving prehospital rPA and sequential control patients from 6 to 12 months before the study who received a fibrinolytic in the hospital.
Acute myocardial infarction was confirmed in 98%. The median time from EMS arrival to initiation of rPA was 31 min (25th to 75th percentile, 24 min to 37 min). The time from EMS arrival to in-hospital fibrinolytic for 630 control patients was 63 min (25th to 75th percentile, 48 min to 89 min), resulting in a time saved of 32 min (p < 0.0001). By 30 min after first medical contact, 49% of study patients had received the first bolus of fibrinolytic compared with only 5% of controls (p < 0.0001). In-hospital mortality was 4.7%. Intracranial hemorrhage occurred in 1.0%.
Prehospital administration of rPA is a feasible approach to accelerating reperfusion in patients with STEMI. Valuable time savings can be achieved in the setting of contemporary transport and door-to-drug times and may translate into an improvement in clinical outcomes.
早期瑞替普酶-心肌梗死溶栓治疗（ER-TIMI）19试验测试了院前推注纤维蛋白溶解剂瑞替普酶（rPA）的可行性，并确定了在当代紧急心脏护理环境中，院前使用rPA节省的时间。
新型推注纤维蛋白溶解剂用于院前给药的评估有限。此外，随着门到用药时间的缩短，先前院前溶栓试验结果的相关性变得不那么确定。
北美20个紧急医疗系统纳入了315例ST段抬高型心肌梗死（STEMI）患者。比较了接受院前rPA的研究患者与研究前6至12个月在医院接受溶栓治疗的序贯对照患者从紧急医疗服务（EMS）到达至给予纤维蛋白溶解剂的时间。
98%的患者确诊为急性心肌梗死。从EMS到达至开始使用rPA的中位时间为31分钟（第25至75百分位数，24分钟至37分钟）。630例对照患者从EMS到达至院内溶栓的时间为63分钟（第25至75百分位数，48分钟至89分钟），节省时间32分钟（p<0.0001）。首次医疗接触后30分钟时，49%的研究患者接受了第一剂纤维蛋白溶解剂，而对照组仅为5%（p<0.0001）。院内死亡率为4.7%。颅内出血发生率为1.0%。
院前给予rPA是加速STEMI患者再灌注的可行方法。在当代转运和门到用药时间的情况下，可以节省宝贵的时间，并可能转化为临床结局的改善。
