[Twelve year triage and thrombolysis treatment prior to hospitalization for myocardial infarction patients in the Rotterdam area of the Netherlands: outstanding short-term and long-term results].
OBJECTIVE
To describe the results of thrombolysis prior to hospitalisation in patients with evolving myocardial infarction.


METHODS
Prospective cohort study.


METHODS
The 'Reperfusion for acute infarcts Rotterdam' (Dutch acronym: REPAIR) programme aims to minimise treatment delay in patients with evolving myocardial infarction by the initiation of thrombolytic therapy prior to hospital admission. For patients with symptoms that indicate a developing myocardial infarction, treatment is initiated immediately by the ambulance personnel at the patient's home, once the diagnosis has been confirmed with the help of a portable 12-lead ECG system. The interval between the onset of symptoms and the thrombolysis infusion was recorded for all patients, as well as any complications which occurred during transportation. The long-term survival was determined using data from the municipal registration.


RESULTS
In the period 1988-2000, 1487 patients were treated using the REPAIR protocol, 80% of these within two hours after the onset of symptoms. In 9 cases (0.6%) a thrombolytic treatment had been initiated, whereas the diagnosis 'myocardial infarction' was not confirmed at the hospital. During transport 40 patients (2.7%) experienced ventricle fibrillation, 25 (1.7%) severe hypotension, and 2 patients (0.1%) died. Mortality at 30 days and at one, five, and ten years was 4.9%, 7.3%, 16.2% en 30.1%, respectively. Patients treated within two hours after the onset of symptoms had lower mortality rates than those treated later: at one year 6.7% versus 9.7%, and at 5 years 14.0% versus 25.1% (Kaplan-Meier estimates; log rank test: p = 0.001).


CONCLUSIONS
Immediate thrombolytic treatment of patients with a developing myocardial infarction which could be safely initiated by ambulance personnel, resulted in excellent short-term and long-term survival.
Boersma
E
E
Klinisch epidemioloog, Academisch Ziekenhuis Rotterdam-Dijkzigt, Thoraxcentrum, afd. Cardiologie, Dr. Molewaterplein 40, 3015 GD Rotterdam. boersma@thch.azr.nl
Maas
A C
AC
Hartman
J A
JA
Ilmer
B
B
Vos
J
J
Simoons
M L
ML
D000368:Aged; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D015996:Survival Rate; D013686:Telemetry; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D014218:Triage