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VIEWS &: REVIEWS
Early thrombolysis saves lives inacuteMI
Although there are data to support the concept of a 'first golden hour' for thrombolytic therapy, early thrombolysis following acute myocardial infarction (MI) may save even more lives than has been recognised, suggest researchers from The Netherlands.
The researchers examined the relationship between treatment delay and 35-day mortality in 22 trials conducted between 1983 and 1993 that investigated the effects of fibrinolytic therapy versus placebo or control, and which included ~ 100 patients. They found that the survival benefit of early treatment is significantly better described by a nonlinear than by a linear function.
More patients could be saved For each 1000 patients with acute MI, the
researchers estimate that 60-80 more will remain alive 1 month later if they receive thrombolytic therapy within 30-60 minutes after the onset of acute MI symptoms than if they received conventional therapy. The corresponding estimate for patients treated within 1-3 hours was 30-50 additional patients alive per 1000 treated.
The researchers recommend that avoidance of treatment delay for patients with suspected acute MI should receive top priority; 'the challenge is to initiate fibrinolytic treatment within the first 2 to 3 hours after symptom onset' , they say. They suggest a public awareness campaign together with the use by ambulance teams and general practitioners of a computer-interpreted 12-lead ECG in any case involving chest pain. BocrmIa E. Maas ACP. Deckers JW. Simeons MI.. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden bour. Lancet 348:
771-775.21 Sep 1996 _72148
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Inphanna- 28 Sep 1111M1 No. 1056