Prehospital thrombolysis in acute myocardial infarction salvages myocardium

Early thrombolysis can be given at home, by a medical intensive care unit ambulance team, in the emergency room, or in the coronary care unit. Thrombolysis should be given very early (< 2 or 4 hours) and reestablish normal or near normal coronary blood flow. Methods of management include home monitoring of high risk patients with a transtelephonic 12-lead monitor ECG, the management of the patient at home by a trained GP, physician, or medical technician controlled intensive care ambulance team, or a rapid 'door to needle' time in the emergency room. Each of these systems requires patient and physician reeducation, to make each group aware of the advantages of early and complete revascularization. An alternative fast track can be provided by immediate percutaneous transluminal coronary angioplasty if the hospital can be prewarned by the physician outside. This article reviews the current published literature and also our experience in 760 patients in Jerusalem. Infarct size, complication rate, and long-term prognosis is related to early complete restoration of coronary blood flow.