Pre-Hospital Thrombolysis in Victoria for Regional STEMI Patients – Is It Ready for Primetime? An Ambulance Victoria Report of 2 Years of Program Outcomes

Murdoch, K.; Sinclaire, E.; Ferrari, Daris; Stubb, D.

doi:10.1016/j.hlc.2016.06.133

Cited by 2 publications

(2 citation statements)

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“…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. Thus, our experience, although non‐randomised, endorses this system of care in the Australian setting and has helped in spreading this system of early fibrinolysis in the ambulance followed by PCI in the other regional centres in Victoria, Queensland and Western Australia …”

Section: Discussionmentioning

confidence: 61%

“…Thus, our experience, although non-randomised, endorses this system of care in the Australian setting and has helped in spreading this system of early fibrinolysis in the ambulance followed by PCI in the other regional centres in Victoria, Queensland and Western Australia. [8][9][10][11] Although primary PCI is the gold standard, guideline recommended treatment for STEMI, we suggest that patients could undergo fibrinolysis if the anticipated time from FMC to balloon inflation is greater than 90 min. 12 In these patients, PHT effectively reduces time to treatment and total ischaemic time, based on studies conducted in higher income countries.…”

Section: P-valuementioning

confidence: 99%

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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

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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.

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Section: Discussionmentioning

confidence: 61%

Section: P-valuementioning

confidence: 99%