EFFICACY OF PREHOSPITAL THROMBOLYTIC THER APY FOR ACUTE MYOCARDIAL-INFARCTION

The efficacy and risk of prehospital thrombolysis for acute myocardial infarction (MI) were evaluated in a randomized trial. Patients receiv ed streptokinase, 500,000 U, and heparin, 10,000 U, intravenously with in 5-10 minutes before (Group 1, n=50) or after (Group 2, n=50) hospit al admission. One hundred patients took conventional therapy (Group 3) . The mean time interval between the onset of symptoms and thrombolyti c therapy was 2.2, 4.5, and 3.8 hours in Groups 1, 2, and 3, respectiv ely (p<0.001). Severe hemorrhagies were absent. The rate of ventricula r fibrillation was the same in Groups 1 and 3 prior to hospitalization . Left ventricular contractility was identical in Groups 1 and 2. By t he end of the fourth week, Group 1 showed a 14 % increase in ejection fraction and a 14.5 % decrease in akinetic segment, these parameters s ubstantially unchanged in Group 2. The MI size assessed by ECG and the maximum myoglobin concentrations was significantly less in Group 1 th an that in Group 2. The patients from Group 1 had fewer MI complicatio ns than those from Groups 2 and 3. Three patients died in Group 1, 6 i n Group 2, and 16 in Group 3. (p<0.05).