OBJECTIVE: Our aim was to determine the relationship among the time saved by administration of thrombolytic therapy in prehospital versus hospital setting and long term mortality; number, duration of hospitalizations and their causes. BACKGROUND: There is much theoretic, experimental and trial evidence to indicate that in @entity583 the earlier the thrombolytic therapy is given, the greater its efficacy. However, the clinical importance of this gain time in long term is still uncertain. SUBJECTS: 280 @entity1 with suspected @entity583 in perspective, controlled study with two parallel groups of consecutive @entity1 without contraindication for thrombolysis, who were seen by general emergency physicians before hospitalization (Gr.1) or later in hospital by the attending cardiologist (Gr.2). The main outcomes measured was mortality rate at 5 years, causes, number and duration of new hospitalizations. RESULTS: The median pain to needle time was 90' (25 degrees percentile:67'; 75 degrees percentile:165') in Gr.1 vs 165' in Gr.2 (25 degrees percentile:110'; 75 degrees percentile:225'). The median time difference was 75' (P<0.001). The 35th day total mortality rate was 7.5% and 10.6% (p:n.s.) in Gr.1 vs Gr.2 respectively, 8.6% (Gr.1) vs 19.7% (Gr.2) (P<0.015) at 1 year, and 19.2% (Gr.1) vs 47.2% (Gr.2) (P<0.015) at 5 years. The percentage of @entity1 with a number of new hospitalizations greater than 1 during 5 years was not significantly different in Gr.1 vs Gr.2 (44.1% vs 48.35, p:n.s.). The total duration of hospitalization was 479 days in Gr.1 vs 1431 days in Gr.2 (P<0.001). The 75 Gr.1 @entity1 alive at the end of 5 years follow up had a mean hospital stay of 3.86+/-5.92 days vs 8.05+/-16.60 days (P<0.036) of the 94 Gr.2 @entity1 alive after 5 years. The total and mean stay for recurrence of @entity697 was significantly different in Gr.1 vs Gr.2 (90 vs 425 days: P<0.001; and 13+/-6.2 days vs 25+/-5.4: P<0.003 respectively). @entity712 led to the 1.16% in Gr.1 vs 9.43% of new admission (P<0.028) for a total of 57 vs 243 days in Gr.1 and Gr.2 respectively (P<0.001). Cumulative mortality rate for any cause at 5 years was 19.2% and 47.2% in prehospital and in hospital treated @entity1 (P<0.015), obtaining diverging survival curves. CONCLUSIONS: The magnitude of the benefit from earlier thrombolysis is such that giving thrombolytic treatment earlier is the main problem to reduce the time from onset of symptoms to reperfusion, to salvage myocardial muscle and obtain diverging survival curves.

The magnitude of the benefit from preCCU thrombolysis in XXXX : a long term follow up.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity583 :: ('MESH:D009203', 'Disease') :: ['acute myocardial infarction'] @entity712 :: ('MESH:D006333', 'Disease') :: ['Cardiac failure'] @entity697 :: ('MESH:D000208', 'Disease') :: ['acute MI']
@entity583 :: (MESH:D009203,Disease) :: ['acute myocardial infarction']
