[Outcomes evaluation after the implementation of a pre-hospital thrombolysis protocol in rural areas].
BACKGROUND
The aim is to evaluate the outcomes obtained from the implementation of a pre-hospital thrombolysis protocol in 3 rural emergency care teams, as well as delays and strategies of reperfusion applied in the treatment of the ST-segment elevation myocardial infarction.


METHODS
Retrospective cohort study (n=52) with historical control (n=20) of the patients assisted for ST-segment elevation myocardial infarction. Medical emergency care teams, hospital, computerized medical history and ARIAM register reports were revised, obtaining epidemiological and clinical features, off-hospital management, reperfusion, time intervals and mortality.


RESULTS
The baseline features in both groups were not significantly different. There was a non-significant improvement of emergency care teams-hospital diagnostic concordance (85.3 versus 76.9%). We found a similar use of nitroglycerin, morphine and aspirin; significant increase (P<0.0001) of clopidogrel/prasugrel (55 versus 90.4%) and enoxaparin/fondaparinux (35 versus 76.9%), as well as pre-hospital thrombolysis (5 versus 30,8%, P<0.03), that was applied within the first 2h to 71.4%, with a median door-needle of 40min, whereas in-hospital thrombolysis and primary angioplasty were performed after 3h from the symptoms onset (P<0.01). Delays are associated with the patient's own lateness (P<0.02). Pharmaco-invasive strategy increases (62.5 versus 84.6%) more than primary angioplasty (15 versus 17.3%), reducing in-hospital thrombolysis (35 versus 19.2%), all of them non-significant. Complications are similar and one-year mortality is reduced (P<0.67).


CONCLUSIONS
The protocol is effective, safe, and reliable. It reduces delays and improves pre-hospital attention. The pharmaco-invasive strategy is a valid option.
Equipo móvil DCCU Montoro, Distrito Córdoba-Guadalquivir, Servicio Andaluz de Salud, Córdoba, España. Electronic address: javihg78@hotmail.com.
J
J
Hernández-García
Servicio de Urgencias, Hospital Universitario Reina Sofía, Servicio Andaluz de Salud, Córdoba, España.
J J
JJ
Giménez-Ruiz
Unidad de Coronarias, Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, Servicio Andaluz de Salud, Córdoba, España.
J M
JM
Dueñas-Jurado
D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019035:Rural Health Services; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy*; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents
Acute coronary syndrome; Fibrinolysis; Fibrinólisis; Síndrome coronario agudo; Terapia trombolítica; Thrombolytic therapy