Grampian Region Early Anistreplase Trial - GREAT

Description:

Prehospital thrombolytics for mortality in acute myocardial infarction.

Hypothesis:

To assess the safety and efficacy of thrombolysis by general practitioners.

Study Design

Study Design:

Patients Screened: Not given
Patients Enrolled: 311
Mean Follow Up: 30 months

Patient Populations:

Suspected acute myocardial infarction.

Primary Endpoints:

Mortality

Drug/Procedures Used:

Anistreplase, 30 mg IV over 5 min, either at home or upon arrival to hospital.

Concomitant Medications:

Aspirin, nitrates

Principal Findings:

Patients were randomized to receive either anistreplase or placebo at home; patients who received home placebo therapy received anistreplase upon arrival to hospital.

Average time to thrombolytic therapy was 101 min for patients receiving anistreplase at home compared to 240 min for patients randomized to receive thrombolytic therapy in the hospital.

At 1 year, patients who had received home thrombolytic therapy had lower mortality (10.4%) compared to patients who received thrombolytic therapy after transport to hospital (21.6%). Mortality within 30 months was highly associated with age and time between start of symptoms and thrombolytic therapy.

For patients who presented more than 2 hours after onset of symptoms, each hour's delay between symptoms and thrombolytic therapy resulted in an estimated 21 deaths/1000 patients within 30 days and 69 deaths/1000 within 30 months.

Interpretation:

The GREAT trial emphasizes the benefit of reducing delays between onset of symptoms and thrombolytic therapy in acute myocardial infarction. This is a particular problem for patients in remote locations. Pre-hospital thrombolytic therapy continues to be evaluated as one method for minimizing delays to treatment and improving survival from acute myocardial infarction.

References:

1. Brit Med J 1992;305:548-63. Final results
2. J Am Coll Cardiol 1994;23:1-5. 1-year mortality
3. Brit Med J 1996;312:212-5. Benefit of early therapy

Clinical Topics: Dyslipidemia, Lipid Metabolism, Novel Agents

Keywords: Thrombolytic Therapy, Myocardial Infarction, Anistreplase, General Practitioners


< Back to Listings