Background:
Achievement of reperfusion with minimal delay is essential for successful treatment of acute myocardial infarction (AMI). Before the establishment of primary percutaneous intervention centers providing 24 hour, 7 days coverage, reperfusion by thrombolysis was the treatment of choice. To minimize delay between vessel occlusion and reperfusion, a prehospital thrombolysis program was initiated in the Rotterdam area. The number of patients treated with pre-hospital thrombolysis rose within a couple years to a stable level, but fell as primary percutaneous intervention developed.
Purpose:
To describe the factors contributing to the rise and decline in the number of patients treated by pre-hospital thrombolysis in the Rotterdam region.
Methods:
Presentation of number of treatments with pre-hospital thrombolysis, rescue PCI and primary PCI from 1980 through 2000<needs to be specified>.
Presentation of timeline with factors that contributed to the rise and decline of pre-hospital thrombolysis.
Results:
Number by year <bar graph of prehospital thrombolysis, rescue PCI and primary PCI>
Factors
-publication demonstrating reperfusion by thrombolysis as treatment in AMI (guideline?)
-publications demonstrating time to reperfusion as a determinant of treatment success in AMI
-developement and implementation of pre-hospital algorithm to stratify patients
-publications demonstrating rescue PCI
-publications on primary PCI vs rescue PCI
-guideline with primary PCI as treatment of choice in AMI
Discussion:
unique setting of rotterdam region
lessons to be learned regarding pre-hospital treatment decisions
role of thrombolysis in present day and age (regions with long transport times, contraindications for PCI)