Community hospital administration of intravenous tissue plasminogen activator in acute myocardial infarction: improved timing, thrombolytic efficacy and ventricular function

Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.

As an investigational fibrinolytic agent for acute myocardial infarction, intravenous recombinant tissue-type plasminogen activator (rt-PA) has been administered primarily in tertiary care and university centers. To determine the value of early initiation of such therapy, two satellite community hospital emergency rooms were established for use of rt-PA and the experience was compared among 142 consecutive patients who were transferred to a regional center for acute cardiac catheterization after intravenous rt-PA therapy. In Group I (n = 19), patients received rt-PA after interhospital transport to the regional center, but before cardiac catheterization. In Group II (n = 70), rt-PA therapy was initiated by the helicopter physician and nurse team after their arrival at the local community hospital emergency room. Group III patients (n = 53) had rt-PA administered in the local community hospital by the emergency room physician. Group III patients had earlier initiation of therapy (2.1 +/- 0.8 hours in Group III versus 3.8 +/- 1.2 hours in combined Groups I and II, p less than 0.001) and an increased rate of infarct vessel recanalization on the 90 minute coronary angiogram (81 in Group III versus 67% in combined Groups I and II, p = 0.057). The patients in Group III had a higher acute left ventricular ejection fraction (54 +/- 8% versus 50 +/- 9.5% in combined Groups I and II, p less than 0.01) and a trend toward an increased 7 day ejection fraction (55.5 +/- 9% versus 51.7 +/- 9.5%, respectively, p = 0.08).(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				J.D. Kovac and A.H. Gershlick How should we detect and manage failed thrombolysis? Eur. Heart J., March 2, 2001; 22(6): 450 - 457. [PDF]

				A. J. Doorey, E. L. Michelson, and E. J. Topol Thrombolytic Therapy of Acute Myocardial Infarction: Keeping the Unfulfilled Promises JAMA, December 2, 1992; 268(21): 3108 - 3114. [Abstract] [PDF]

				L. K. Chouhan, H. A. Hajar, T. George, and J. C. Pomposiello Clinical and Angiographic Features of Patients from the Indian Subcontinent Treated with Intravenous Streptokinase for Acute Myocardial Infarction: Experience in Qatar Angiology, August 1, 1992; 43(8): 641 - 646. [Abstract] [PDF]

				E. J. Topol, D. R. Holmes, and W. J. Rogers Coronary Angiography after Thrombolytic Therapy for Acute Myocardial Infarction Ann Intern Med, May 15, 1991; 114(10): 877 - 885. [Abstract] [PDF]

				S. Sherry and V. J. Marder Streptokinase and Recombinant Tissue Plasminogen Activator (rt-PA) Are Equally Effective in Treating Acute Myocardial Infarction Ann Intern Med, March 1, 1991; 114(5): 417 - 423. [Abstract] [PDF]

				D. W. M. Muller and E. J. Topol Selection of Patients with Acute Myocardial Infarction for Thrombolytic Therapy Ann Intern Med, December 15, 1990; 113(12): 949 - 960. [Abstract] [PDF]

				D. Collen Coronary Thrombolysis: Streptokinase or Recombinant Tissue-Type Plasminogen Activator? Ann Intern Med, April 1, 1990; 112(7): 529 - 538. [Abstract] [PDF]

				S. W. Sharkey, D. D. Brunette, E. Ruiz, W. T. Hession, D. G. Wysham, I. F. Goldenberg, and M. Hodges An Analysis of Time Delays Preceding Thrombolysis for Acute Myocardial Infarction JAMA, December 8, 1989; 262(22): 3171 - 3174. [Abstract] [PDF]

				D. A. Tate and G. J. Dehmer New Challenges for Thrombolytic Therapy Ann Intern Med, June 15, 1989; 110(12): 953 - 955. [Abstract] [PDF]

				E. J. Topol Coronary Angioplasty for Acute Myocardial Infarction Ann Intern Med, December 15, 1988; 109(12): 970 - 980. [Abstract] [PDF]

				THROMBOLYTIC THERAPY MORE EFFECTIVE AT COMMUNITY HOSPITALS Journal Watch (General), December 15, 1987; 1987(1215): 3 - 3. [Full Text]