Published online before print September 27, 2004, doi: 10.1161/01.CIR.0000143144.82338.36
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(Circulation. 2004;110:1909-1915.)
© 2004 American Heart Association, Inc.
Coronary Heart Disease |
Impact of Prehospital Thrombolysis for Acute Myocardial Infarction on 1-Year Outcome
Results From the French Nationwide USIC 2000 Registry
From Service de Cardiologie, Hôpital Européen Georges Pompidou, Paris (N.D.); Clinique St Gatien, Tours (D.B.); Hôpital Bichat, Paris (P.G.S.); Hôpital Necker, Paris (P.S.); Centre Hospitalier d’Aulnay, Aulnay (G.H.); Centre Hospitalier Régional Universitaire de Lille, Lille (P. Goldstein, J.-M.L.); INSERM U 558, Toulouse (J.-P.C.); Hôpital Henri Mondor, Créteil (P. Guéret); and Laboratoire Aventis, Paris (L.V., Y.B., N.G.), France.
Correspondence to Nicolas Danchin, MD, FESC, FACC, Service de Cardiologie, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France. E-mail nicolas.danchin{at}egp.ap-hop-paris.fr
Received March 25, 2004; de novo received May 5, 2004; revision received June 9, 2004; accepted June 10, 2004.
Background— Limited data are available on the impact of prehospital thrombolysis (PHT) in the "real-world" setting.
Methods and Results— Of 443 intensive care units in France, 369 (83%) prospectively collected all cases of infarction (
48 hours of symptom onset) in November 2000; 1922 patients (median age, 67 years; 73% men) with ST-segment–elevation infarction were included, of whom 180 (9%) received intravenous thrombolysis before hospital admission (PHT). Patients with PHT were younger than those with in-hospital thrombolysis, primary percutaneous interventions, or no reperfusion therapy. Median time from symptom onset to hospital admission was 3.6 hours for PHT, 3.5 hours for in-hospital lysis, 3.2 hours for primary percutaneous interventions, and 12 hours for no reperfusion therapy. In-hospital death was 3.3% for PHT, 8.0% for in-hospital lysis, 6.7% for primary percutaneous interventions, and 12.2% for no reperfusion therapy. One-year survival was 94%, 89%, 89%, and 79%, respectively. In a multivariate analysis of predictors of 1-year survival, PHT was associated with a 0.49 relative risk of death (95% CI, 0.24 to 1.00; P=0.05). When the analysis was limited to patients receiving reperfusion therapy, the relative risk of death for PHT was 0.52 (95% CI, 0.25 to 1.08; P=0.08). In patients with PHT admitted in 3.5 hours, in-hospital mortality was 0% and 1-year survival was 99%.
Conclusions— The 1-year outcome of patients treated with PHT compares favorably with that of patients treated with other modes of reperfusion therapy; this favorable trend persists after multivariate adjustment. Patients with PHT admitted very early have a very high 1-year survival rate.
Key Words: outcome assessment • intensive care • myocardial infarction • thrombolysis
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