[Early systemic thrombolysis in acute myocardial infarct. Comparison between the clinical and the prehospital phase].

Short-term systemic thrombolytic treatment was undertaken in 84 patients--within the first three hours after onset of pain; with typical ECG signs of acute transmural myocardial infarction; refractory to nitroglycerin--either in an intensive care unit (n = 40) or in a medically-staffed ambulance (n = 44). Coronary angiography was undertaken in patients of both groups, after obtaining informed consent, at the earliest possible moments, combined with percutaneous transluminal coronary angioplasty (PTCA), if indicated. Thrombolytic treatment in the ambulance was primarily more effective (72%, n = 32) than in the ICU patients (47.5%; n = 19), and the pain-thrombolysis interval shorter by 30 min. The higher recurrent infarction rate in the former meant that the success rate at the end of the hospital stay did not significantly differ between the two groups (54.5% and 47.5%, respectively). Only when early systemic thrombolysis was combined with PTCA within the first three hours (n = 26) was there a markedly greater effectiveness after four weeks (77%) than without PTCA (40%). Early thrombolytic treatment by doctors in the ambulance during transfer to hospital is sensible only if it can be followed at once by coronary angiography with PTCA or operation soon after admission. Only in this way will the effectiveness of treatment be increased and maintained after discharge from hospital.