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Very early trombolytic therapy in suspected acute myocardial infarction
[external]. (Prehospital akutsjukvård)
1990 (engelsk)Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 65, nr 7, s. 401-407Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Three hundred fifty-two patients with suspected acute myocardial infarction (AMI) were randomized to placebo (175) or tissue-type plasminogen activator (rt-PA) (177). Patients were eligible if evaluated within 165 minutes from onset of chest pain and if age was <75 years. Electrocardiographic criteria were not required. A mobile coronary care unit with a cardiologist present was used to initiate treatment at home in 29% of the patients. Primary endpoints were infarct size (serum lactate dehydrogenase isoenzyme1 activity), left ventricular function (radioangiography) and exercise capacity at 30 days. AMI was diagnosed in 59% of all randomized patients. The incidence was similar in the 2 groups (placebo, 108, rt-PA, 101). Among all randomized patients, rt-PA was associated with significantly decreased infarct size and an increased ejection fraction. Among rt-PA-treated patients there were significantly fewer Q-wave infarctions. No difference in exercise capacity could be detected. No benefit was found in subgroups of patients without ST-segment elevation on the initial electrocardiogram. There were 18 (10.3%) and 11 (6.2%) deaths (p = 0.23) within 30 days in the placebo and rt-PA groups, respectively. Adverse reactions were similar in both groups with no excess of complications in the home-treated group. Very early treatment with rt-PA in patients with a strong suspicion of AMI and ST-segment elevation limits infarct size and improves left ventricular function. The infarct pattern is shifted from Q-wave to non-Q-wave infarcts by rt-PA. The study suggests that thrombolysis can be given before hospital admission without additional risk. Furthermore, etectrocardiographic records are useful for selection of patients.

sted, utgiver, år, opplag, sider
Excerpta Medica, Inc. , 1990. Vol. 65, nr 7, s. 401-407
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URN: urn:nbn:se:hb:diva-7669DOI: 10.1016/0002-9149(90)90800-GLokal ID: 2320/8537OAI: oai:DiVA.org:hb-7669DiVA, id: diva2:888550
Tilgjengelig fra: 2015-12-22 Laget: 2015-12-22 Sist oppdatert: 2017-12-01bibliografisk kontrollert

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