title: Safety and delay time in prehospital thrombolysis of acute myocardial infarction in urban and rural areas in Sweden.
abstract: Sixteen hospitals in Sweden, including those in urban and more sparsely populated areas, and the associated ambulance organizations were enrolled in a prospective evaluation of the feasibility of treating patients with a ST-elevation infarction with a thrombolytic agent (reteplase) before hospital admission. A physician staffed the ambulances in 1% of cases, a nurse in 67%, and a staff nurse in 32% of cases. In all, 64 patients in urban areas and 90 patients in rural areas were included. The occurrence of complications before hospital admission was low and similar in the 2 groups. The median interval between the onset of symptoms and the start of thrombolysis was 1 hour 44 minutes in urban areas versus 2 hours 14 minutes in rural areas (P = 0.03). The median arrival time (interval between onset of symptoms and arrival of the ambulance) tended to be shorter in urban areas (1 hr 10 min vs 1 hr 33 min; not significant) and the median interval between the arrival of the ambulance and the start of thrombolysis was shorter in urban areas (27 min vs 36 min; P < 0.0001). When comparing urban areas with the least-populated rural areas, differences in various delay times became even more marked. Patients in urban areas had a higher ejection fraction and fewer symptoms of heart failure after 30 days and a lower 1-year mortality.
authors.affiliation: Division of Cardiology, South Hospital, SE-118 83 Stockholm, Sweden. leif.svensson@medklin.sos.sll.se
authors.forename: Leif
authors.initials: L
authors.lastname: Svensson
authors.forename: Thomas
authors.initials: T
authors.lastname: Karlsson
authors.forename: Rolf
authors.initials: R
authors.lastname: Nordlander
authors.forename: Magnus
authors.initials: M
authors.lastname: Wahlin
authors.forename: Crister
authors.initials: C
authors.lastname: Zedigh
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
mesh_terms: D000368:Aged; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy*; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012423:Rural Health; D012449:Safety; D013548:Sweden; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014504:Urban Health
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; C087896:reteplase; D010959:Tissue Plasminogen Activator