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Verwertbare Ergebnisse
To determine the theoretical risk/benefit ratio of prehospital thrombolytic treatment, the European Myocardial Infarction Project (EMIP) was established. In a double blind, randomised trial, prehospital thrombolysis was compared with in hospital treatment. Anistreplase was the chosen thrombolytic agent because, being administered as a bolus, it is suitable for a prehospital setting. The study involved 5469 patients who received either 30 units of anistreplase at home followed by placebo after hospital admission, or placebo at home followed by 30 units of anistreplase after hospital admission. In 92.4% of cases, the diagnosis of suspected myocardial infarction was confirmed by the hospital cardiologist. Minor adverse reactions were more frequent in the early treatment group but the incidence of severe adverse reactions such as cerebral bleeding, ischaemicstrokes and severe bleeding was similar in both groups. As severe bleeding was among the main concerns expressed about prehospital thrombolysis, it is important to note that there was no occurrence of severe bleeding before admission and only one after admission, prior to the second injection. The frequency of reinfarction, ventricular fibrillation, acute pulmonary oedema, shock and cardiac arrest was the same in both groups. A total of 569 deaths was observed at 30 days, mortality being 13% lower in the early treatment group. The risk ratio decreased with increasing time gained by early treatment (the interval between injections). Death from cardiac causes was 16% lower in the early treatment arm, the result being at the limit of statistical significance (p=0.049). EMIP has thus proved prehospital thrombolysis to be feasible and safe, with no more incorrect diagnosis of myocardial infarction than in hospital, provided that the teams are well equipped and staffed.
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