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Pre‐hospital thrombolysis for ST‐segment elevation myocardial infarction in regional Australia: long‐term follow up
Author(s) -
Khan Arshad A.,
Williams Trent,
AlOmary Mohamed S.,
Feeney Alex L.,
Majeed Tazeen,
Savage Lindsay,
Stewart Paul,
Faddy Steven,
Collins Nicholas J.,
Fletcher Peter,
Boyle Andrew J.
Publication year - 2020
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14412
Subject(s) - medicine , conventional pci , interquartile range , thrombolysis , myocardial infarction , percutaneous coronary intervention , cardiac catheterisation , reperfusion therapy , st segment , cardiology , interventional cardiology , emergency medicine
Abstract Background Delivering reperfusion therapy to patients with ST‐segment elevation myocardial infarction (STEMI) in regional areas without access to tertiary cardiology care remains challenging. The systems of care in Hunter New England Health, New South Wales, Australia (area covered = 130 000 km 2 ) to provide reperfusion to patients with STEMI involve a 12‐lead electrocardiogram in the ambulance, discussion between cardiologist and paramedic, followed by pre‐hospital thrombolysis (PHT) delivered in ambulance to appropriate patients >60 min from the cardiac catheterisation laboratories. Patients who can access the cardiac catheterisation laboratories within 60 min are treated with primary percutaneous coronary intervention (PCI). Aims We have previously reported excellent 12‐month outcomes for patients receiving PHT and the aim of the current analysis is to look at the long term outcomes. Methods We assessed long‐term all‐cause mortality and major adverse cardiovascular events of STEMI patients undergoing PHT in our health district from August 2008 to August 2013 and compared with the primary PCI group. Results One hundred and fifty (mean age: 62 ± 13 years, males: 76%, n = 114) patients were administered PHT and 334 patients (mean age: 65 ± 13 years, males: 75%, n = 251) underwent primary PCI during the study period. During a median follow up of 6.2 years (interquartile range: 4.8–7.4 years) all‐cause mortality was 16% and 19% in the PHT and primary PCI groups respectively ( P = 0.4). Conclusion Our real‐world experience shows that PHT followed by early transfer to a primary PCI‐capable centre is an effective reperfusion strategy, with comparable results to primary PCI, and mortality benefits are sustained to more than 6 years.