Feasibility and long term outcome of home vs hospital initiated thrombolysis

McAleer, B.; Varma, M. P. S.

doi:10.1007/bf03167961

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…One meta‐analysis, 13 three randomised controlled trials 16 ‐ 18 and three cohort studies 27 ‐ 29 were included. In non‐tertiary hospitals, PHT may be most suitable as a substitute for IHT, and multiple studies have evaluated its role in this setting.…”

Section: Resultsmentioning

confidence: 99%

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How can we prevent and treat cardiogenic shock in patients who present to non‐tertiary hospitals with myocardial infarction? A systematic review

O’Connor¹

2009

Medical Journal of Australia

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Objective: To evaluate current evidence in support of therapies for preventing and treating cardiogenic shock (CS) after acute myocardial infarction that can be initiated in hospitals without invasive cardiac facilities. Study design: Systematic review. Data sources: MEDLINE and PubMed were searched from January 1985 to May 2008 using the MeSH terms “myocardial infarction”, “thrombolytic therapy”, “shock, cardiogenic”, “angioplasty, transluminal, percutaneous coronary”, “intra‐aortic balloon pumping” and “platelet aggregation inhibitors”. Additional keyword and reference list searches were performed. Articles in English relating to adults were included. Study selection: Meta‐analyses and comparative studies were included if they reported mortality or prevention of CS as an endpoint. In total, 35 articles were analysed (four meta‐analyses, eight randomised controlled trials and 23 cohort studies). Data extraction: Studies were summarised by the first author and the level of evidence graded. Each study was checked by the second author and consensus was reached about inclusion and levels of evidence. Data synthesis: In the management and prevention of CS, the following are supported by high‐level evidence: prehospital thrombolysis, transfer for emergency revascularisation (patients aged < 75 years) and thrombolysis for older patients (patients aged ≥ 75 years). In established CS, evidence supporting inhospital thrombolysis and intra‐aortic balloon pump use in patients aged < 75 years and emergency revascularisation in older patients is limited to subgroup analyses and observational studies. Conclusions: In regional centres, prevention of CS is achieved with early fibrinolysis, preferably before hospital arrival. Patients of all ages should be considered for thrombolysis, early transfer for coronary revascularisation, and intra‐aortic balloon pump insertion unless contraindicated. Glycoprotein inhibitors have no role in the management of CS in non‐tertiary hospitals.

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Section: Resultsmentioning

confidence: 99%

“…Since then, three further studies have shown a mortality benefit and a significant reduction in CS with PHT compared with IHT 27 . ‐ 29 …”

Section: Resultsmentioning

confidence: 99%

How can we prevent and treat cardiogenic shock in patients who present to non‐tertiary hospitals with myocardial infarction? A systematic review

O’Connor¹

2009

Medical Journal of Australia

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Pre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction

McCaul

Lourens

Kredo

2014

Cochrane Database of Systematic Reviews

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Strategy to Reduce Mortality Rates of ST-elevation Acute Myocardial Infarction Using Prehospital Thrombolysis: A Meta-analysis

Ramadoss,

Pari,

Santhi

et al. 2024

Research in Cardiovascular Medicine

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Importance: Ischemic heart disease is the leading cause of death worldwide. In ST-elevation myocardial infarction (STEMI), delaying reperfusion from the onset of chest pain increases the incidence of mortality and morbidity. Prehospital thrombolysis (PHT) has been evaluated in the setting of STEMI. We performed a systematic analysis of studies of PHT in acute STEMI. Objective: The objective of this study was to evaluate the all-cause mortality benefit in STEMI with PHT during short-term and long-term follow-up. Data Sources: In December 2020, the Cochrane search strategy was used to analyze randomized control trials, nonrandomized control studies, and registry studies in PubMed, EMBASE, Cochrane Library, Google Scholar, ClinicalKey, and Clinical Trial Registries. The search was repeated, and the included studies were updated in June 2023 to include more recent literature. We restricted the analysis to full-text publications in English. Study Selection: Studies using any thrombolytic agent in treating acute myocardial infarction in prehospital and inhospital settings with or without percutaneous Coronary intervention (PCI) were included in the analysis. Selection criteria included patient history and symptoms, electrocardiogram findings, and cardiac markers. Data Extraction: We used the Cochrane Handbook for Systematic Reviews of Interventions for assessing bias, the PRISMA flow diagram to show the process of inclusion and exclusion of studies, and RevMan software to perform meta-analysis. Main Outcomes and Measures: Outcomes include all-cause hospital mortality rate of PHT versus inhospital thrombolysis (IHT), influence of ischemic median time on all-cause mortality with PHT, and effect of PHT before PCI. The measures must have been observed for a follow-up period of up to 35 days, 1-year, and 5-years. Results: Data from 63,814 patients from 32 studies were reviewed. Results indicate a reduction in all-cause mortality in patients assigned to PHT (odds ratio [OR] −0.68, P < 0.00001) compared to IHT. There was a significant reduction in mortality when thrombolytics were administered before PCI (OR − 0.78, P = 0.0001). The overall survival was better with an ischemic time of <2 h. Mortality was higher with longer ischemic time (3 h and 6 h). Among patients who presented within 2 h of the onset of chest pain, mortality was lower compared to primary PCI (pPCI). Conclusion: PHT offers faster reperfusion and reduces all-cause mortality compared to IHT. A strategy of PHT within the first 2-3 h of ischemic pain followed by PCI (if indicated) could offer better survival than pPCI.

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Feasibility and long term outcome of home vs hospital initiated thrombolysis

Abstract: Pre-hospital thrombolysis by MCCU is feasible and allows significant reduction in the delay time to treatment initiation. There are encouraging improvements in short- and long-term survival with no apparent reduction in safety profile.

Cited by 3 publications

References 16 publications

How can we prevent and treat cardiogenic shock in patients who present to non‐tertiary hospitals with myocardial infarction? A systematic review

How can we prevent and treat cardiogenic shock in patients who present to non‐tertiary hospitals with myocardial infarction? A systematic review

Pre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction

Strategy to Reduce Mortality Rates of ST-elevation Acute Myocardial Infarction Using Prehospital Thrombolysis: A Meta-analysis

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