[Earlier treatment of acute myocardial infarction with administration of alteplase (rt-PA) before hospitalization].
The gain in survival by thrombolytic therapy in patients with myocardial infarction is determined by the delay between coronary occlusion and reperfusion. The REPAIR study was designed to examine the feasibility and safety of prehospital thrombolysis with alteplase (rt-PA, Actilyse). Indications and contraindications are verified by general practitioner or ambulance nurse with a short questionnaire. A small portable ECG computer system is used to confirm the presence of a large evolving myocardial infarction 'on the spot'. Between June 1988 and May 1990, 150 patients were treated by the ambulance service. Therapy could be initiated within an average of 91 (+/- 40) minutes (sd) after the onset of symptoms, and within 23 (+/- 9) minutes after ambulance arrival. Three patients were defibrillated during transportation, in one of these therapy had to be discontinued because of cardiac massage. No other complications were observed. Five patients (3%) died after arrival in the hospital. The time gained by prehospital treatment averaged 47 (+/- 2) minutes in comparison with 220 patients who received thrombolytic therapy after hospital admission. The procedure allows rapid and safe initiation of thrombolytic therapy in selected patients, even in the absence of a physician.
Bouten
M J
MJ
Academisch Ziekenhuis Rotterdam-Dijkzigt, Thoraxcentrum, afd. Cardiologie.
Simoons
M L
ML
Hartman
J A
JA
van Miltenburg
A J
AJ
van der Does
E
E
Pool
J
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D011379:Prognosis; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D010959:Tissue Plasminogen Activator
Snellere behandeling van het acute myocardinfarct door toediening van alteplase (rt-PA) vóór opname.