Further support for prebospitaI thrombolytics

Prehospital thrombolytic therapy is safe and feasible in cases of suspected acute MI, according to the European Myocardial Infarction Project (EMIP) Group.

Cardiac mortality was 16% lower in patients who were given anistreplase 30U by emergency medical personnel before hospital admission (n = 2750; prehospital group) compared with patients who received the agent after hospital admission (2719; hospital group). And, although not significant, overall 30-day mortality was reduced 13% by prehospital anistreplase.

These results confirm those of 4 other studies. Combined results of the 5 studies indicate a significant 17% reduction in short-term mortality by prehospital thrombolytic administration.

In the EMIP trial, all patients received anistreplase within 6 hours of symptom onset. But, patients in the prehospital group received anistreplase a median of 55 min earlier than those in the hospital group. The diagnosis of MI in the prehospital setting, determined by the result of a 12-lead ECG, was found reliable in 90% of patients.

The incidence of major complications, including bleeding and stroke, was similar in the two groups. The incidences of some minor complications, such as ventricular fibrillation, were higher in the prehospital group prior to admission. However, the between-group difference in ventricular fibrillation was offset by a higher incidence of this compli­cation during hospital admission for patients in the hospital group. Nevertheless, as thrombolytic therapy may trigger arrhythmia, EMIP Group researchers 'strongly recommend that a defibrillator be available in the ambulance '. Loizorovicz A, Boissel JP. Julian D, Castaigne A, Haugh Me, et al. Prehospital thrombolytic therapy in patients with suspected acute myocardial infarction. New England Journal of Medicine 329: 383-389,5

THERAPY

Aug 1993 800214>25

ISSN 0156-2703l9310814-00171$1.00C Adis International Ltd

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INPHARMA" 14 Aug 1993