Pre‐hospital thrombolysis in ST‐segment elevation myocardial infarction: a regional Australian experience

Khan, Akhtar A.; Williams, Trenton A.; Savage, L.; Stewart, Paul; Ashraf, Asma; Davies, Allan; Faddy, Steven; Attia, John; Oldmeadow, Christopher; Bhagwandeen, Rohan; Fletcher, Peter; Boyle, Andrew

doi:10.5694/mja15.01336

Cited by 19 publications

(14 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our experience is unique, as Australia has a different geography from the rest of the developed world, with the biggest challenge being the large transport distances in the rural and regional areas . We previously reported that PHT could be delivered successfully by paramedical staff in the regional settings with excellent clinical outcomes at 1 year . This sustained clinical benefit to over 6 years presented herein endorses the spread of the PHT approach to other healthcare networks where provision of timely primary PCI remains challenging.…”

Section: Discussionmentioning

confidence: 60%

“…In 2008, we introduced a system of care to provide early reperfusion to our STEMI patients; this involves pre‐hospital diagnosis and triage by paramedics using 12‐lead electrocardiogram (ECG) followed by either pre‐hospital thrombolysis (PHT) in the ambulance or primary PCI, according to their travel time to the CCL. We have already published 1‐year outcomes on our patients (PHT vs primary PCI) and the aim of the current analysis is to report our extended follow up.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pre‐hospital thrombolysis for ST‐segment elevation myocardial infarction in regional Australia: long‐term follow up

Khan

Williams

Al‐Omary

et al. 2020

Internal Medicine Journal

Self Cite

View full text Add to dashboard Cite

Background Delivering reperfusion therapy to patients with ST‐segment elevation myocardial infarction (STEMI) in regional areas without access to tertiary cardiology care remains challenging. The systems of care in Hunter New England Health, New South Wales, Australia (area covered = 130 000 km2) to provide reperfusion to patients with STEMI involve a 12‐lead electrocardiogram in the ambulance, discussion between cardiologist and paramedic, followed by pre‐hospital thrombolysis (PHT) delivered in ambulance to appropriate patients >60 min from the cardiac catheterisation laboratories. Patients who can access the cardiac catheterisation laboratories within 60 min are treated with primary percutaneous coronary intervention (PCI). Aims We have previously reported excellent 12‐month outcomes for patients receiving PHT and the aim of the current analysis is to look at the long term outcomes. Methods We assessed long‐term all‐cause mortality and major adverse cardiovascular events of STEMI patients undergoing PHT in our health district from August 2008 to August 2013 and compared with the primary PCI group. Results One hundred and fifty (mean age: 62 ± 13 years, males: 76%, n = 114) patients were administered PHT and 334 patients (mean age: 65 ± 13 years, males: 75%, n = 251) underwent primary PCI during the study period. During a median follow up of 6.2 years (interquartile range: 4.8–7.4 years) all‐cause mortality was 16% and 19% in the PHT and primary PCI groups respectively (P = 0.4). Conclusion Our real‐world experience shows that PHT followed by early transfer to a primary PCI‐capable centre is an effective reperfusion strategy, with comparable results to primary PCI, and mortality benefits are sustained to more than 6 years.

show abstract

Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Pre‐hospital thrombolysis for ST‐segment elevation myocardial infarction in regional Australia: long‐term follow up

Khan

Williams

Al‐Omary

et al. 2020

Internal Medicine Journal

Self Cite

View full text Add to dashboard Cite

show abstract

“…Es extremadamente importante tener siempre in mente que el objetivo final es la reperfusión ya sea con fibrinólisis PH o ACP. En los pacientes en los cuales la ACP no es factible dentro de los intervalos de tiempo recomendados, como es al caso en muchos lugares de Chile, debe realizarse, de ser posible, fibrinolisis PH, como está bien descrito en las guías del MINSAL 11 y otras publicaciones que confirman la mayor efectividad de la fibrinolisis PH que en el hospital 4, [33][34][35][36][37][38][39] .…”

Section: Fibrinolisis Prehospitalariaunclassified

Infarto Agudo del Miocardio: conducta en el período prehospitalario

Escobar

Akel

2019

Rev Chil Cardiol

View full text Add to dashboard Cite

“…The Hunter New England health district covers an area of 130,000 square kilometres served by a single PPCI centre. The prehospital triage of patients in the Hunter region presenting with STEMI to the New South Wales Ambulance Service (NSWAS) has been described in detail previously [ 2 ]. Briefly, paramedics record a 12-lead electrocardiogram for all patients with symptoms suggestive of myocardial infarction.…”

Section: Introductionmentioning

confidence: 99%

Keys to Achieving Target First Medical Contact to Balloon Times and Bypassing Emergency Department More Important Than Distance

Ezad

Davies

Cheema

et al. 2018

Cardiology Research and Practice

Self Cite

View full text Add to dashboard Cite

Background Australian guidelines advocate primary percutaneous coronary intervention (PPCI) as the reperfusion strategy of choice for ST elevation myocardial infarction (STEMI) in patients in whom it can be performed within 90 minutes of first medical contact; otherwise, fibrinolytic therapy is preferred. In a large health district, the reperfusion strategy is often chosen in the prehospital setting. We sought to identify a distance from a PCI centre, which made it unlikely first medical contact to balloon time (FMCTB) of less than 90 minutes could be achieved in the Hunter New England health district and to identify causes of delay in patients who were triaged to a PPCI strategy. Methods and Results We studied 116 patients presenting via the ambulance service with STEMI from January 2016 to December 2016. In patients who were taken directly to the cardiac catheterisation lab, a maximum distance of 50 km from hospital resulted in 75% of patients receiving PCI within 90 minutes and approximately 95% of patients receiving PCI within 120 minutes. Patients who bypassed the emergency department (ED) were significantly more likely to have FMCTB of less than 90 minutes (p < 0.001) despite having a longer travel distance (28.5 km versus 17.4 km, p < 0.001). Patients transiting via the ED were significantly more likely to present out of hours (60 versus 24.2% p < 0.001). Conclusions Patients who do not bypass the ED have a longer FMCTB across all spectrum of distances from the PCI centre; therefore, bypassing the ED is key to achieving target FMCTB times. Using a cutoff distance of 50 km may reduce human error in estimating travel time to our PCI centre and thereby identifying patients who should receive prehospital thrombolysis.

show abstract

Pre‐hospital thrombolysis in ST‐segment elevation myocardial infarction: a regional Australian experience

Abstract: PHT can be delivered safely by paramedical staff in regional and rural Australia with good clinical outcomes.

Cited by 19 publications

References 17 publications

Pre‐hospital thrombolysis for ST‐segment elevation myocardial infarction in regional Australia: long‐term follow up

Pre‐hospital thrombolysis for ST‐segment elevation myocardial infarction in regional Australia: long‐term follow up

Infarto Agudo del Miocardio: conducta en el período prehospitalario

Keys to Achieving Target First Medical Contact to Balloon Times and Bypassing Emergency Department More Important Than Distance

Contact Info

Product

Resources

About