Prehospital thrombolysis in rural emergency room and subsequent transport to a coronary care unit: Ravenna Myocardial Infarction (RaMI) trial.
OBJECTIVE
To assess the feasibility, safety and efficacy of thrombolysis in the Emergency Room of a Rural Hospital with no Coronary Care Unit, and subsequent transfer to the Coronary Care Unit of a City Hospital.


METHODS
Prospective study, controlled with two parallel groups of consecutive patients (Group 1: Rural Hospital, Group 2: CCU Ravenna) and administration of Anistreplase 30 intravenous unit.


METHODS
Rural Emergency Rooms which transmitted the electrocardiogram by cardiotelephone to the Ravenna Coronary Care Unit (average distance 35 km; range: 17-50 km).


METHODS
280 (Group 1: 102 patients, Group 2: 178 patients) with suspected acute myocardial infarction and with no contra-indications to fibrinolysis, within 6 h of onset of symptoms.


METHODS
time saving, accuracy of diagnosis, adverse events, left ventricular function and survival.


RESULTS
the median pain to needle time was 90' in Group 1 and 165' in Group 2 (P < 0.001). Accuracy of diagnosis for acute myocardial infarction was 91% and 100%, respectively. Complications were rare and none occurred during transfer. The creatine phosphokinase peak of Group 1 was lower than Group 2 (1389 vs. 2186 IU/l; P < 0.001). The echocardiographic Wall Motion Abnormality Score Index of Group 1 was lower than Group 2 (3.571 vs. 5.589; P < 0.001). Mortality at 35 days in Group 1 was 7.5% vs. 10.7% in Group 2 (-30%; P = n.s.).


CONCLUSIONS
The Emergency Room physician, in close collaboration with the cardiologist, supplied a very high standard of pre-Coronary Care Unit diagnosis and therapy. Administration of Anistreplase in the rural Emergency Room brought about a significant reduction of pain to needle time, a significant improvement in left ventricular function and a reduction in mortality.
Coccolini
S
S
Cardiology Department, S. Maria delle Croci Hospital, Azienda U.S.L. Ravenna, Italy.
Berti
G
G
Bosi
S
S
Pretolani
M
M
Tumiotto
G
G
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016255:Anistreplase / Q000008:administration & dosage / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000209:etiology; D016009:Chi-Square Distribution; D004452:Echocardiography; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D006780:Hospitals, Rural; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011446:Prospective Studies; D015996:Survival Rate; D013686:Telemetry; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016277:Ventricular Function, Left
D005343:Fibrinolytic Agents; D016255:Anistreplase