[Prehospital diagnosis and treatment of acute myocardial infarction in Vestfold].
BACKGROUND
Pre-hospital thrombolysis is a relatively new treatment modality in Norway. The present study is a county-based evaluation of the first phase of this procedure after its introduction in 2002.


METHODS
This is a retrospective cohort study of all patients who, over a nine-month period, had a pre-hospital ECG taken by paramedics and transmitted to the county's two coronary care units. The medical records of all patients who received pre-hospital thrombolysis were analysed and compared with those who received in-hospital thrombolysis over the same period.


METHODS
A pre-hospital ECG was successfully taken and transmitted in 840 patients. Pre-hospital thrombolytic therapy was given to 45 (5.4%) patients, of whom 38 (84%) developed ST-elevation myocardial infarction (STEMI). Over the same period, 32 patients received in-hospital thrombolysis, of whom 28 (87%) developed STEMI. Among the 738 hospitalised patients who did not receive pre-hospital thrombolytic therapy, 218 (28%) had a diagnosis of acute coronary syndrome, 258 (35%) had established coronary heart disease but no evidence of coronary ischaemia, while 262 (36%) had no evidence of coronary heart disease at all. Median call-to-thrombolysis time was 42 minutes (range 21-75).


CONCLUSIONS
The findings indicate good paramedical pre-hospital routines with short call-to-thrombolysis-time, but the routines for pre-hospital ECG and thrombolytic therapy need reassessment.
Aune
Erlend
E
Hjerteseksjonen, Klinikk Medisin, Sykehuset i Vestfold, 3103 Tønsberg. erlend.aune@siv.no
Steen-Hansen
Jon Erik
JE
Hjelmesaeth
Jøran
J
Otterstad
Jan Erik
JE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D015331:Cohort Studies; D004562:Electrocardiography; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D009664:Norway / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects; D016896:Treatment Outcome