The European Myocardial Infarction Project: an assessment of pre-hospital thrombolysis.
The use of thrombolytic agents in patients with suspected myocardial infarction has been shown to reduce early and long-term mortality by about 20%, and it has been suggested that since time is an important factor, pre-hospital treatment would give better results. However, health deciders need reliable data on which to base future policies concerning this. The European Myocardial Infarction Project was a European Economic Community-supported double-blind study designed to evaluate the efficacy and safety of pre-hospital early thrombolytic treatment in patients with suspected myocardial infarction compared with the same treatment given later in a hospital setting. A total of 5469 patients in 16 countries were randomised by 198 mobile emergency units to receive either pre-hospital treatment with anistreplase, the thrombolytic agent used, followed by placebo after hospital admission (pre-hospital group; 2750 patients), or placebo followed by anistreplase (hospital group; 2719 patients). The median time delay between the injections was 55 min. A non-significant decrease in 30-day mortality was observed in favour of the pre-hospital group (13%: P = 0.08), whereas the decrease in cardiac death observed, also in favour of the pre-hospital group, was on the borderline of significance (16%; P = 0.049). Although some complications occurred more frequently in the pre-hospital group in the pre-hospital period, the overall incidence for serious complications was similar for both groups. These results show that the pre-hospital thrombolytic strategy in patients with suspected myocardial infarction is both effective and safe when performed by well-equipped well-staffed mobile emergency units.
Boissel
J P
JP
Service de Pharmacologie Clinique, Lyon, France.
D000552:Ambulances; D016255:Anistreplase / Q000008:administration & dosage* / Q000009:adverse effects; D002170:Canada; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D004632:Emergency Medical Services / Q000379:methods*; D005060:Europe; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007275:Injections, Intravenous; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D016255:Anistreplase