Rawles J
Medicines Assessment Research Unit, University of Aberdeen, Scotland, United Kingdom.
J Am Coll Cardiol. 1994 Jan;23(1):1-5. doi: 10.1016/0735-1097(94)90494-4.
Our aim was to determine the time saved by administration of thrombolytic therapy at home rather than in the hospital and to assess whether earlier thrombolysis resulted in decreased mortality from acute myocardial infarction.
There is much theoretic, experimental and trial evidence to indicate that in acute myocardial infarction the earlier that thrombolytic therapy is given, the greater its efficacy. However, the clinical importance of this time effect is uncertain.
In a randomized double-blind parallel-group clinical trial, 311 patients with suspected acute myocardial infarction seen by their general practitioners within 4 h of symptom onset were given intravenous anistreplase (30 U) either at home or later, after arrival in the hospital.
Anistreplase was given at home or in the hospital at median times of 101 and 240 min, respectively, after symptom onset. The median time saved by domiciliary thrombolysis was 130 min. By the end of 1 year after trial entry, 17 (10.4%) of 163 patients given anistreplase at home died compared with 32 (21.6%) of 148 in those allotted anistreplase in the hospital (relative reduction 52%, 95% confidence interval 14% to 89%, p = 0.007).
In this trial the time saved by domiciliary thrombolysis by primary care physicians was > 2 h. It is likely that a similar time saving would be achieved if prehospital thrombolysis were to become established practice. Prehospital thrombolysis resulted in a halving of the mortality rate from acute myocardial infarction.
我们的目的是确定在家而非在医院进行溶栓治疗所节省的时间，并评估早期溶栓是否能降低急性心肌梗死的死亡率。
有大量理论、实验和试验证据表明，在急性心肌梗死中，溶栓治疗给予得越早，其疗效越好。然而，这种时间效应的临床重要性尚不确定。
在一项随机双盲平行组临床试验中，311例症状发作后4小时内被全科医生诊治的疑似急性心肌梗死患者，在家中或到达医院后接受静脉注射茴酰化纤溶酶原链激酶激活剂复合物（30U）。
症状发作后，在家中和医院给予茴酰化纤溶酶原链激酶激活剂复合物的中位时间分别为101分钟和240分钟。家庭溶栓节省的中位时间为130分钟。试验入组1年后，在家中接受茴酰化纤溶酶原链激酶激活剂复合物治疗的163例患者中有17例（10.4%）死亡，而在医院接受该治疗的148例中有32例（21.6%）死亡（相对降低52%，95%置信区间14%至89%，p = 0.007）。
在本试验中，初级保健医生进行家庭溶栓节省的时间超过2小时。如果院前溶栓成为既定做法，可能会节省类似的时间。院前溶栓使急性心肌梗死的死亡率减半。
