Resumen
Objectives: The primary objective of this report was to describe the infrastructures and processes of selected European and North American pre-hospital fibrinolysis (PHL) programs. A secondary objective is to report the outcome data of the PHL programs surveyed. Background: Despite its benefit in reducing mortality in patients with ST-segment elevation myocardial infarction, PHL remained underused in North America. Examination of existing programs may provide insights to help address barriers to the implementation of PHL. Methods: The leading investigators of PHL research projects/national registries were invited to respond to a survey on the organization and outcomes of their affiliated PHL programs. Results: PHL was successfully deployed in a wide range of geographic territories (Europe: France, Sweden, Vienna, England, and Wales; North America: Houston, Edmonton, and Nova Scotia) and was delivered by healthcare professionals of varying expertise. In-hospital major adverse outcomes were rare with mortality of 3% to 6%, reinfarction of 2% to 5%, and stroke of <2%. Conclusions: Combining formal protocols for PHL for some patients with direct transportation of others to a percutaneous coronary intervention hospital for primary percutaneous coronary intervention would allow for tailored reperfusion therapy for patients with ST-segment elevation myocardial infarction. Insights from a variety of international settings may promote widespread use of PHL and increase timely coronary reperfusion worldwide.
| Idioma original | English |
|---|---|
| Páginas (desde-hasta) | 877-883 |
| Número de páginas | 7 |
| Publicación | JACC: Cardiovascular Interventions |
| Volumen | 4 |
| N.º | 8 |
| DOI | |
| Estado | Published - ago. 2011 |
Nota bibliográfica
Funding Information:The MINAP (Myocardial Ischemia National Audit Project) and Cardiovascular Health Nova Scotia were funded mainly by government health agencies. The AMICO, RIKS-HIA, and Vienna STEMI Registry received partial support from pharmaceutical companies, and the Vienna STEMI Registry was partially supported by the Association for the Promotion of Research in Arteriosclerosis, Thrombosis, and Vascular Biology. The Unités des Soins Intensives Coronariens 2000 registry was funded by Aventis. The FAST-MI is a registry of the French Society of Cardiology, funded by unrestricted grants from Pfizer and Servier , and by an additional grant from the Caisse Nationale d'assurance-maladie (National Health Insurance system). Dr. Huynh has received minor grants for organization of educational symposia from RocheCanada in 2009 and 2010. Dr. O'Loughlin holds a Canada Research Chair in the Early Determinants of Adult Chronic Disease. Dr. Stenestrand was the President of the RIKS-HIA Registry. Dr. Schull holds a Canadian Institutes of Health Research Applied Chair in Health Services and Policy Research. Dr. Welsh has received research grants from Boehringer Ingelheim , AstraZeneca , Sanofi-Aventis , Eli Lilly , Portola , Abbott , and Medtronic ; and he was on the advisory boards for and received honorarium from AstraZeneca, Bristol-Myers Squibb, Sanofi-Aventis, Roche, and Eli Lilly. Dr. Tu is supported by a Tier 1 Canada Research Chair in Health Services Research and a career investigator award from the Heart and Stroke Foundation of Ontario. Dr. Danchin has received lecturing/consulting fees from AstraZeneca, Eli Lilly, Novo, Sanofi-Aventis and Servier; lecture fees from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Menarini, Merck-Serono, MSD-Schering-Plough, Servier, and Sanofi-Aventis; and grant support from AstraZeneca , Eli Lilly , GlaxoSmithKline , Merck-Schering-Plough , Novartis , Pfizer , Sanofi-Aventis , Servier and The Medicines Company . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dr. Ulf Stenestrand is deceased.
ASJC Scopus Subject Areas
- Cardiology and Cardiovascular Medicine