Time savings with prehospital thrombolysis in an urban area

The aim of this study was to evaluate the time saved by prehospital thrombolysis compared with the usual inhospital reperfusion strategies in Geneva, Switzerland, a moderate-sized urban area with short transportation times (median time 4 min). Patients with acute myocardial infarction, diagnosed clinically and by means of a 12-lead electrocardiogram in a mobile intensive care unit, without contraindications to thrombolysis, were randomly assigned either to 'prehospital thrombolysis' or to 'usual hospital care', i.e. inhospital reperfusion strategies (thrombolysis or primary angioplasty). Sixteen patients with similar clinical characteristics were randomly selected. The mean time between the arrival of the physician by the patient and the initiation of therapy was shorter for 'prehospital thrombolysis' (26.0+/-10.3 min) than for 'usual hospital care' (94.93+/-6.3 min, P=0.0004). Time savings were even greater when time between the beginning of symptoms and the initiation of therapy was analysed (152.6+/-76.6 versus 251.2+/-86.3 min, P=0.0004). We concluded that, even in an urban area with a readily available catheterization laboratory, prehospital thrombolysis can be initiated safely immediately after the diagnosis of acute myocardial infarction, and is time saving.