[Out-of-hospital treatment and 1-year survival in patients with ST-elevation acute myocardial infarction. Results of the Spanish Out-of-Hospital Fibrinolysis Evaluation Project (PEFEX)].
OBJECTIVE
To investigate out-of-hospital treatment, including fibrinolysis, in patients with ST-elevation acute myocardial infarction and to determine the 1-year survival rate.


METHODS
Prospective cohort study based on an ongoing out-of-hospital registry of patients with ST-elevation acute myocardial infarction who were treated by out-of-hospital emergency teams in Andalusia, Spain during 2001-2004. Patients were followed up in hospital and one year after the acute episode.


RESULTS
The study involved 2372 patients. Out-of-hospital fibrinolysis was used in 467 (19.7%). Among these, 20.7% received treatment within the first hour, 68% within the first 2 hours, and 2 (0.4%) hemorrhagic strokes occurred. Episodes of ventricular fibrillation were recorded in 158 patients (6.7%), 106 (67%) of whom were discharged. In addition, 386 (16.3%) patients died in the short term (both out of and in hospital), with 26 (1.1%) dying before they reached hospital. The cumulative 1-year mortality rate was 22.4% (531 patients) overall, and 6.6% (29 patients) in the out-of-hospital fibrinolysis group. Increased survival at 1 year was associated with out-of-hospital fibrinolysis (odds ratio [OR]=0.368; 95% confidence interval [CI], 0.238-0.566) and percutaneous coronary intervention during admission (OR=0.445; 95% CI, 0.268-0.740).


CONCLUSIONS
In routine clinical practice, out-of-hospital fibrinolysis was performed safely, reduced short-term mortality, and improved the 1-year survival rate. The combination of appropriate out-of-hospital treatment, including early defibrillation and fibrinolysis within the first three hours, together with the systematic application of percutaneous coronary intervention during hospital admission is a suitable treatment strategy for the comprehensive care of patients with ST-elevation acute myocardial infarction.
Rosell-Ortiz
Fernando
F
Empresa Pública de Emergencias Sanitarias, Almería, España. frosell@al.epes.es
Mellado-Vergel
Francisco J
FJ
Ruiz-Bailén
Manuel
M
Perea-Milla
Emilio
E
D000368:Aged; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D011446:Prospective Studies; D015996:Survival Rate; D015912:Thrombolytic Therapy; D013997:Time Factors