Feasibility and long term outcome of home vs hospital initiated thrombolysis.

BACKGROUND

Thrombolytic therapy improves mortality in acute myocardial infarction especially in those who receive treatment early. Pre-hospital therapy can reduce the time to treatment.

METHODS

Open, randomized study of patients with acute myocardial infarction of less than six hours duration in a rural community. Pre-hospital thrombolysis was administered using a mobile coronary care unit (MCCU) and all patients received IV streptokinase.

RESULTS

Two-hundred and forty-eight patients were studied, 82 in the MCCU and 166 in the hospital group. The mean delay time to treatment was 136 minutes (MCCU group) and 196 minutes (hospital group) (p < 0.001). Reperfusion time was 116 minutes for the MCCU group and 118 minutes for the hospital group. Mortality at 30 days was 4.9% for the MCCU group and 15.7% for the hospital group (p = 0.014). Mortality at one year was 9.8% for the MCCU group and 23.5% for the hospital group (p = 0.009). Mortality for patients followed up to five years was 17.7% for the MCCU group and 35.2% for the hospital group (p = 0.005). There were no significant adverse events in either treatment group.

CONCLUSION

Pre-hospital thrombolysis by MCCU is feasible and allows significant reduction in the delay time to treatment initiation. There are encouraging improvements in short- and long-term survival with no apparent reduction in safety profile.