[The safety of the treatment of an acute myocardial infarct by immediate intravenous fibrinolysis in the regional hospital environment].
OBJECTIVE
Our aim was to evaluate the utility of thrombolytic therapy administered outside tertiary hospital.


METHODS
We analyzed 80 consecutive patients with acute myocardial infarction admitted to the emergency area of primary hospital within 24 hours after the onset of symptoms and lastly transported to a coronary care unit (CCU) of a reference hospital. The thrombolytic protocol was performed by medicine department of primary hospital and the CCU of reference hospital.


RESULTS
23 patients without (group A) and 57 with (group B) fibrinolytic therapy (APSAC 50 patients and streptokinase 7 patients) were analyzed. Group A patient were older (mean: 67 +/- 11 vs mean: 62 +/- 10 years; p = 0.01), and arrived later to emergency area (mean 254 +/- 284 vs mean 163 SD 161 min; p = 0.04) and to the coronary care unit (mean 561 +/- 371 vs mean 334 +/- 177 min; p = 0.0002). The guard physician decision to start or not the fibrinolytic therapy, was adequate in 86% of the patients (sensitivity 87%, predictive positive value 95%, specificity 83%). Complications on emergency area or during transport in group B were ventricular fibrillation in 9%, AV block (2-3 degree) in 9%, severe nonsustained ventricular arrhythmia in 11% and transitory hypotension in 23%. No death occurred before CCU admission. In group B, 35% patients was treated within the first 2 hours. The average time gain was 124 min (thrombolysis administration--CCU admission).


CONCLUSIONS
On emergency area of primary hospital, thrombolytic therapy is feasible and safe when administered by well-equipped and well-trained medical emergence area and ambulance staff.
Bermejo García
J
J
Servicio de Cardiología, Hospital Universitario de Valladolid.
Casero Lambás
A
A
Durán Hernández
J M
JM
Alonso Martín
J
J
Ramos López
B
B
Muñoz San José
J C
JC
Guillem Ares
E
E
Bartolomé Aragón
A
A
Gamazo Chillón
F
F
San José Díez
J
J
D000368:Aged; D016255:Anistreplase / Q000008:administration & dosage*; D003325:Coronary Care Units; D004630:Emergencies; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D012449:Safety; D013030:Spain; D015912:Thrombolytic Therapy / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors
D016255:Anistreplase
Seguridad del tratamiento del infarto agudo de miocardio mediante fibrinólisis intravenosa inmediata en el ámbito hospitalario comarcal.