title: Pre-hospital thrombolysis delivered by paramedics is associated with reduced time delay and mortality in ambulance-transported real-life patients with ST-elevation myocardial infarction.
abstract: OBJECTIVE
  There are sparse data on the impact of pre-hospital thrombolysis (PHT) in real-life patients. We therefore evaluated treatment delays and outcome in a large cohort of ambulance-transported real-life patients with ST-elevation myocardial infarction (STEMI) according to PHT delivered by paramedics or in-hospital thrombolysis.
  
  
  RESULTS
  Prospective cohort study used data from the Swedish Register of Cardiac intensive care on patients admitted to the coronary care units of 75 Swedish hospitals in 2001-2004. Ambulance-transported thrombolytic-treated patients younger than age 80 with a diagnosis of acute myocardial infarction were included. Patients with PHT (n=1690) were younger, had a lower prevalence of co-morbid conditions, fewer complications, and a higher ejection fraction (EF) than in-hospital-treated patients (n=3685). Median time from symptom onset to treatment was 113 min for PHT and 165 min for in-hospital thrombolysis. One-year mortality was 7.2 vs. 11.8% for PHT and in-hospital thrombolysis, respectively. In a multivariable analysis, after adjusting for baseline characteristics and rescue angioplasty, PHT was associated with lower 1-year mortality (odds ratio 0.71, 0.55-0.92, P=0.008).
  
  
  CONCLUSIONS
  When compared with regular in-hospital thrombolysis, pre-hospital diagnosis and thrombolysis with trained paramedics in the ambulances are associated with reduced time to thrombolysis by almost 1 h and reduced adjusted 1-year mortality by 30% in real-life STEMI patients.
authors.affiliation: Department of Cardiology, University Hospital of Uppsala, 751 85 Uppsala Sweden. erik.bjorklund@akademiska.se
authors.forename: Erik
authors.initials: E
authors.lastname: Björklund
authors.forename: Ulf
authors.initials: U
authors.lastname: Stenestrand
authors.forename: Johan
authors.initials: J
authors.lastname: Lindbäck
authors.forename: Leif
authors.initials: L
authors.lastname: Svensson
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
mesh_terms: D000368:Aged; D000552:Ambulances; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D015912:Thrombolytic Therapy / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D014187:Transportation of Patients; D016896:Treatment Outcome