title: Pre-hospital thrombolysis in ST-segment elevation myocardial infarction: a regional Australian experience.
abstract: OBJECTIVE
  The system of care in the Hunter New England Local Health District for patients with ST-segment elevation myocardial infarction (STEMI) foresees pre-hospital thrombolysis (PHT) administered by paramedics to patients more than 60 minutes from the cardiac catheterisation laboratory (CCL), and primary percutaneous coronary intervention (PCI) at the CCL for others. We assessed the safety and effectiveness of the pre-hospital diagnosis strategy, which allocates patients to PHT or primary PCI according to travel time to the CCL.
  
  
  METHODS
  Prospective, non-randomised, consecutive, single-centre case series of STEMI patients diagnosed on the basis of a pre-hospital electrocardiogram (ECG), from August 2008 to August 2013. All patients were treated at the tertiary referral hospital (John Hunter Hospital, Newcastle).
  
  
  METHODS
  The primary efficacy endpoint was all-cause mortality at 12 months; the primary safety endpoint was bleeding.
  
  
  RESULTS
  STEMI was diagnosed in 484 patients on the basis of pre-hospital ECG; 150 were administered PHT and 334 underwent primary PCI. The median time from first medical contact (FMC) to PHT was 35 minutes (IQR, 28-43 min) and to balloon inflation 130 minutes (IQR, 100-150 min). In the PHT group, 37 patients (27%) needed rescue PCI (median time, 4 h; IQR, 3-5 h). The 12-month all-cause mortality rate was 7.0% (PHT, 6.7%; PCI, 7.2%). The incidence of major bleeding (TIMI criteria) in the PHT group was 1.3%; no patients in the primary PCI group experienced major bleeding.
  
  
  CONCLUSIONS
  PHT can be delivered safely by paramedical staff in regional and rural Australia with good clinical outcomes.
authors.affiliation: John Hunter Hospital, Newcastle, NSW andrew.boyle@newcastle.edu.au.
authors.forename: Arshad A
authors.initials: AA
authors.lastname: Khan
authors.affiliation: John Hunter Hospital, Newcastle, NSW.
authors.forename: Trent
authors.initials: T
authors.lastname: Williams
authors.affiliation: John Hunter Hospital, Newcastle, NSW.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Savage
authors.affiliation: NSW Ambulance, Sydney, NSW.
authors.forename: Paul
authors.initials: P
authors.lastname: Stewart
authors.affiliation: Hunter Medical Research Institute, University of Newcastle, Newcastle.
authors.forename: Asma
authors.initials: A
authors.lastname: Ashraf
authors.affiliation: John Hunter Hospital, Newcastle, NSW.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Davies
authors.affiliation: NSW Ambulance, Sydney, NSW.
authors.forename: Steven
authors.initials: S
authors.lastname: Faddy
authors.affiliation: John Hunter Hospital, Newcastle, NSW.
authors.forename: John
authors.initials: J
authors.lastname: Attia
authors.affiliation: Hunter Medical Research Institute, University of Newcastle, Newcastle.
authors.forename: Christopher
authors.initials: C
authors.lastname: Oldmeadow
authors.affiliation: John Hunter Hospital, Newcastle, NSW.
authors.forename: Rohan
authors.initials: R
authors.lastname: Bhagwandeen
authors.affiliation: John Hunter Hospital, Newcastle, NSW.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fletcher
authors.affiliation: John Hunter Hospital, Newcastle, NSW.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Boyle
mesh_terms: D001315:Australia; D004562:Electrocardiography; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D011446:Prospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents