Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway
Background: Prehospital thrombolytic therapy given by ambulance emergency medical services to patients with acute ST-segment elevation myocardial infarction (STEMI) may produce earlier reperfusion than percutaneous coronary intervention. Clinical results from prehospital thrombolytic therapy in rura...
Published in: | European Heart Journal: Acute Cardiovascular Care |
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2017
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croxfordunivpr:10.1177/2048872617748550 2024-10-06T13:46:27+00:00 Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway Mannsverk, Jan Steigen, Terje Wang, Harald Tande, Pål Morten Dahle, Birgitte Mannsverk Nedrejord, Maret Lajla Hokland, Ida Olsen Gilbert, Mads 2017 http://dx.doi.org/10.1177/2048872617748550 http://journals.sagepub.com/doi/pdf/10.1177/2048872617748550 http://journals.sagepub.com/doi/full-xml/10.1177/2048872617748550 en eng Oxford University Press (OUP) http://journals.sagepub.com/page/policies/text-and-data-mining-license European Heart Journal: Acute Cardiovascular Care volume 8, issue 1, page 8-14 ISSN 2048-8726 2048-8734 journal-article 2017 croxfordunivpr https://doi.org/10.1177/2048872617748550 2024-09-10T04:13:03Z Background: Prehospital thrombolytic therapy given by ambulance emergency medical services to patients with acute ST-segment elevation myocardial infarction (STEMI) may produce earlier reperfusion than percutaneous coronary intervention. Clinical results from prehospital thrombolytic therapy in rural areas are scarce. Methods: We studied outcomes during 11 years of a prehospital thrombolytic therapy system in rural sub-arctic Norway. Ambulance personnel gave protocol basic treatment and transmitted electrocardiograms to hospital physicians who made the decision for prehospital thrombolytic therapy. The study was divided into three time periods; 2000–2003, 2004–2007 and 2008–2011. Results: A total of 385 STEMI patients received prehospital thrombolytic therapy, median patient age was 61.2 years, and 77% were men. Time saved by prehospital reperfusion therapy was 131 minutes. The proportion who got prehospital thrombolytic therapy within 2 hours of symptom onset increased from 21% in 2000–2003 to 39% in 2008–2011 ( P=0.003). The proportion who underwent coronary angiography or percutaneous coronary intervention within 24 hours of first medical contact increased from 56.4% to 95.4% ( P<0.001). Post-STEMI systolic heart failure decreased from 19.4% to 8.1% ( P=0.02), while 1-year mortality fell, non-significantly, by 50% over time to reach 5.6%. Thirteen patients suffered acute out-of-hospital cardiac arrest; all were successfully defibrillated. Ten patients had major bleeding events (2.6%). Conclusion: A decentralised prehospital thrombolytic therapy system based on ambulance personnel, telemetry and centralised 7/24 invasive diagnosis and treatment service, combined with system maturation over time, was associated with earlier reperfusion, improved clinical outcomes and better survival. Prehospital thrombolytic therapy is a feasible and safe intervention used in rural settings with long evacuation lines to percutaneous coronary intervention facilities. Article in Journal/Newspaper Arctic Oxford University Press Arctic Norway European Heart Journal: Acute Cardiovascular Care 8 1 8 14 |
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Open Polar |
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Oxford University Press |
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croxfordunivpr |
language |
English |
description |
Background: Prehospital thrombolytic therapy given by ambulance emergency medical services to patients with acute ST-segment elevation myocardial infarction (STEMI) may produce earlier reperfusion than percutaneous coronary intervention. Clinical results from prehospital thrombolytic therapy in rural areas are scarce. Methods: We studied outcomes during 11 years of a prehospital thrombolytic therapy system in rural sub-arctic Norway. Ambulance personnel gave protocol basic treatment and transmitted electrocardiograms to hospital physicians who made the decision for prehospital thrombolytic therapy. The study was divided into three time periods; 2000–2003, 2004–2007 and 2008–2011. Results: A total of 385 STEMI patients received prehospital thrombolytic therapy, median patient age was 61.2 years, and 77% were men. Time saved by prehospital reperfusion therapy was 131 minutes. The proportion who got prehospital thrombolytic therapy within 2 hours of symptom onset increased from 21% in 2000–2003 to 39% in 2008–2011 ( P=0.003). The proportion who underwent coronary angiography or percutaneous coronary intervention within 24 hours of first medical contact increased from 56.4% to 95.4% ( P<0.001). Post-STEMI systolic heart failure decreased from 19.4% to 8.1% ( P=0.02), while 1-year mortality fell, non-significantly, by 50% over time to reach 5.6%. Thirteen patients suffered acute out-of-hospital cardiac arrest; all were successfully defibrillated. Ten patients had major bleeding events (2.6%). Conclusion: A decentralised prehospital thrombolytic therapy system based on ambulance personnel, telemetry and centralised 7/24 invasive diagnosis and treatment service, combined with system maturation over time, was associated with earlier reperfusion, improved clinical outcomes and better survival. Prehospital thrombolytic therapy is a feasible and safe intervention used in rural settings with long evacuation lines to percutaneous coronary intervention facilities. |
format |
Article in Journal/Newspaper |
author |
Mannsverk, Jan Steigen, Terje Wang, Harald Tande, Pål Morten Dahle, Birgitte Mannsverk Nedrejord, Maret Lajla Hokland, Ida Olsen Gilbert, Mads |
spellingShingle |
Mannsverk, Jan Steigen, Terje Wang, Harald Tande, Pål Morten Dahle, Birgitte Mannsverk Nedrejord, Maret Lajla Hokland, Ida Olsen Gilbert, Mads Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway |
author_facet |
Mannsverk, Jan Steigen, Terje Wang, Harald Tande, Pål Morten Dahle, Birgitte Mannsverk Nedrejord, Maret Lajla Hokland, Ida Olsen Gilbert, Mads |
author_sort |
Mannsverk, Jan |
title |
Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway |
title_short |
Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway |
title_full |
Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway |
title_fullStr |
Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway |
title_full_unstemmed |
Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway |
title_sort |
trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for st-elevation myocardial infarction in rural sub-arctic norway |
publisher |
Oxford University Press (OUP) |
publishDate |
2017 |
url |
http://dx.doi.org/10.1177/2048872617748550 http://journals.sagepub.com/doi/pdf/10.1177/2048872617748550 http://journals.sagepub.com/doi/full-xml/10.1177/2048872617748550 |
geographic |
Arctic Norway |
geographic_facet |
Arctic Norway |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
European Heart Journal: Acute Cardiovascular Care volume 8, issue 1, page 8-14 ISSN 2048-8726 2048-8734 |
op_rights |
http://journals.sagepub.com/page/policies/text-and-data-mining-license |
op_doi |
https://doi.org/10.1177/2048872617748550 |
container_title |
European Heart Journal: Acute Cardiovascular Care |
container_volume |
8 |
container_issue |
1 |
container_start_page |
8 |
op_container_end_page |
14 |
_version_ |
1812174776319344640 |