12 jaar triage en trombolytische behandeling vóór ziekenhuisopname bij hartinfarctpatiënten in de regio Rotterdam: uitstekende korte- en langetermijnresultaten

To describe the results of thrombolysis prior to hospitalisation in patients with evolving myocardial infarction.

Design

Prospective cohort study.

Method

The ‘Reperfusion for acute infarcts Rotterdam’ (Dutch acronym: REPAIR) programme aims to minimise treatment delay in patients with evolving myocardial infarction by the initiation of thrombolytic therapy prior to hospital admission. For patients with symptoms that indicate a developing myocardial infarction, treatment is initiated immediately by the ambulance personnel at the patient's home, once the diagnosis has been confirmed with the help of a portable 12-lead ECG system. The interval between the onset of symptoms and the thrombolysis infusion was recorded for all patients, as well as any complications which occurred during transportation. The long-term survival was determined using data from the municipal registration.

Results

In the period 1988-2000, 1487 patients were treated using the REPAIR protocol, 80 of these within two hours after the onset of symptoms. In 9 cases (0.6) a thrombolytic treatment had been initiated, whereas the diagnosis ‘myocardial infarction’ was not confirmed at the hospital. During transport 40 patients (2.7) experienced ventricle fibrillation, 25 (1.7) severe hypotension, and 2 patients (0.1) died. Mortality at 30 days and at one, five, and ten years was 4.9, 7.3, 16.2 en 30.1, respectively. Patients treated within two hours after the onset of symptoms had lower mortality rates than those treated later: at one year 6.7 versus 9.7, and at 5 years 14.0 versus 25.1 (Kaplan-Meier estimates; log rank test: p = 0.001).

Conclusion

Immediate thrombolytic treatment of patients with a developing myocardial infarction which could be safely initiated by ambulance personnel, resulted in excellent short-term and long-term survival.