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Evaluation of the time saved byprehospital initiation of reteplase forST-elevation myocardial infarction

Results of the early retavase-thrombolysisin myocardial infarction (ER-TIMI) 19 trial

David A. Morrow, MD, MPH^*,*, Elliott M. Antman, MD, FACC^*, Assaad Sayah, MD, Kristin C. Schuhwerk, BS^*, Robert P. Giugliano, MD, SM^*, James A. deLemos, MD, Michael Waller, MD, Sidney A. Cohen, MD, Donald G. Rosenberg, MD^||, Sally S. Cutler, MBA^*, Carolyn H. McCabe, BS^*, Ron M. Walls, MD^¶, Eugene Braunwald, MD, FACC^* Early Retavase-Thrombolysis In Myocardial Infarction (ER-TIMI) 19 Investigators

^* Cardiovascular Division and TIMI Study Group, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Department of Emergency Medicine, Good Samaritan Medical Center, Brockton, Massachusetts, USA
Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
Centocor, Inc., Malvern, Pennsylvania, USA
^|| Division of Cardiology, University of Florida, Miami, Florida, USA
^¶ Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

View larger version (18K): [in a new window]   Figure 1 Cumulative distribution of time to initiation of fibrinolytic from emergency medical service (EMS) arrival for patients treated with prehospital reteplase (rPA) versus in-hospital fibrinolytic. ER TIMI 19 = Early Retavase Thrombolysis In Myocardial Infarction 19 trial.

View larger version (22K): [in a new window]   Figure 2 Proportion of patients with complete (>70%) ST-segment resolution (STRES) plotted by time from emergency medical service (EMS) arrival. Time to treatment data are from Early Retavase-Thrombolysis In Myocardial Infarction 19 (ER-TIMI 19) trial patients treated with reteplase (rPA) and historical controls. ST-segment resolution data for patients treated with in-hospital fibrinolytic are from prior TIMI trials interpreted by the TIMI Electrocardiogram Core Laboratory, Boston, Massachusetts (17,18). ED = emergency department.