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Prehospital Reteplase Safely Shaves 30 minutes off time to MI Treatment. (ER TIMI-19).

ANAHEIM, CALIF. -- Prehospital administration of thrombolytics by emergency medical system personnel can shave 30 minutes or more off the time interval between a 911 call and initiation of thrombolytic therapy in a patient with a potential MI.

Results of the Early Reteplase Thrombolysis in Myocardial Infarction-19 (ER TIMI-19) trial, reported by Dr. David A. Morrow at the annual scientific sessions of the American Heart Association, demonstrate that even in communities where ambulance transport times average 20-30 minutes-considered pretty typical across the United States--prehospital administration of thrombolytics by EMS personnel saved an average of 31 minutes.

ER TIMI-19 was designed to assess the practicality of prehospital thrombolysis in diverse real-world American settings. Most prior studies of prehospital thrombolysis were conducted in other countries.

In ER TIMI-19, more than 300 lytic-eligible patients with acute MI in 20 geographically diverse North American communities received prehospital thrombolysis. The control group consisted of 594 sequential acute MI patients treated in the same hospitals in the prior 6-12 months.

Before ER TIMI-19, Dr. Morrow and the other study investigators conducted what he termed a "relatively straightforward" training program to teach EMS personnel and physicians in participating communities about prehospital confirmation and treatment of acute MI.

In hospitals having transport times greater than 30 minutes, prehospital administration of rereplase in ER TIMI-19 saved an average of 48 minutes in time to treatment. Even in communities where ambulance transport times for acute MI patients averaged less than 20 minutes, prehospital thrombolysis by EMS personnel saved 23 minutes, said Dr. Morrow of Brigham and Women's Hospital, Boston.

The same pattern was noted with regard to door-to-drug time. In hospitals where less than 20 minutes goes by on average between the time a patient with a possible MI comes through the ER door and initiation of thrombolytic therapy, prehospital initiation of thrombolysis saved only 3.5 minutes. But with door-to-drug times of 20-40 minutes, which are quite typical in the United States, prehospital thrombolysis saved an average of 30 minutes in time to treatment. Where door-to-drug times in ER TIMI-19 exceeded 40 minutes, prehospital thrombolysis saved 47.5 minutes.

ER TIMI-19 wasn't big enough to show differences in clinical outcome based on time to treatment. But a wealth of data from the early reperfusion era resulted in the dictum that "time is heart muscle."
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Author:Jancin, Bruce
Publication:Internal Medicine News
Geographic Code:1USA
Date:Jan 1, 2002
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