De veiligheid en effectiviteit van trombolyse tijdens ambulancetransport van patiënten met een acuut hartinfarct

– We studied the safety and efficacy of thrombolytic therapy for acute myocardial infarction initiated prior to ambulance transport. Intravenous streptokinase with 5 x 10⁵IU (SK-i.v.) was started in 40 patients (group A) before transport and 36 patients (group B) after transport. In all patients immediate coronary angiography was performed, followed by intracoronary streptokinase. Infarct size was assessed from cumulative release of α– hydroxybutyrate dehydrogenase. No procedure-related complications were seen during transport. The time to SK-i.v. was 70 minutes in group A versus 125 minutes in group B. At first visualisation the infarct-related vessel was patent in 23 patients (58) in group A and in 6 patients (17) in group B (p < 0.001). For anterior wall infarction we found a 32 smaller infarct size in group A (p < 0.05). We conclude that SK-i.v. during ambulance transport is safe, increases early reperfusion and leads to a further reduction of infarct size which is significant in anterior wall infarction.