Early intravenous thrombolysis in acute myocardial infarction: the Jerusalem experience

Myocardial damage in acute myocardial infarction is a time-dependent process. We examined the influence of very early thrombolytic therapy, comparing prehospital to hospital administration, in a consecutive group of patients with myocardial infarction on mortality, complications and the preservation of left ventricular function. Seven hundred sixty patients received early thrombolytic therapy: 114 at home (time delay to treatment 1.4 ± 0.8 h) and 646 in hospital (2.1 ± 1.0 h). Sixteen patients died in hospital and significant hemorrhage occurred in 15 (including three patients with hemorrhagic stroke). There was no difference between groups in hospital mortality or rate of complications. The duration of ischemia was shorter in patients with prehospital therapy (pain duration: 3.3 ± 2.1 vs. 4.0 ± 2.2; P < 0.05, and time to recovery of the ST segment in the electrocardiogram: 4.3 ± 3.3 vs. 6.6 ± 6.3; P < 0.002). Peak plasma creatine kinase was earlier in patients with prehospital therapy (11.2 ± 5.0 vs. 13.0 ± 5.8; P < 0.002), although there was no difference between groups in the absolute peak plasma level. Left ventricular function was assessed by contrast ventriculography 1 week after admission (616 patients). Ventricular function was better in patients with prehospital therapy: (ejection fraction of 58 ± 13% vs. 54 ± 15%; P < 0.05 and a left ventricular dysfunction index of 534 ± 515 vs. 691 ± 519 units; P < 0.05). We conclude that prehospital thrombolytic therapy is feasible and safe. Reperfusion is achieved earlier and more myocardium can be salvaged using this strategy without increasing the rate of complications.