Myocardial Infarction Triage and Intervention Project--phase II - MITI II
Prehospital thrombolytics for mortality in acute myocardial infarction.
Prehospital initiation of thrombolytic therapy might provide the opportunity to treat a large proportion of patients within the first 2 hours of symptom onset.
Patients Screened: Not given
Patients Enrolled: 360
<75 years old who were alert, oriented, and had ongoing chest discomfort of suspected cardiac origin for >15 minutes and <6 hours
Systolic blood pressure >80 and <180 mm Hg
Diastolic blood pressure <120 mmHg and a systolic blood pressure difference between arms <20 mmHg (to minimize the possibility of aortic dissection)
Chest pain >6 hours from symptom onset
Age >75 years
Presence of complicating illnesses that were considered to be contraindications for prehospital thrombolytic therapy
Survival and event-free survival, defined as survival free of death, MI, or hospitalization for angina, congestive heart failure, or revascularization.
Aspirin or recombinant tissue plasminogen activator, either before or after hospital arrival.
IV sodium heparin
Two-year survival was 89% for prehospital- and 91% for hospital-treated patients (p = 0.46).
Event-free survival at 2 years was 56% and 64% for prehospital- and hospital-treated patients, respectively (p = 0.42).
In patients treated < 70 minutes from symptom onset, 2-year survival was 98%, and it was 88% for those treated later (p = 0.12).
Two-year event-free survival was 65% for patients treated early and 59% for patients treated later (p = 0.80).
In this trial, poorer long-term survival was associated with advanced age, history of congestive heart failure, and coronary artery bypass surgery performed before the index hospitalization, but not with time to treatment.
1. Am J Cardiol 1996;78:497-502. Final results
Clinical Topics: Cardiac Surgery, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Lipid Metabolism, Acute Heart Failure
Keywords: Thrombolytic Therapy, Myocardial Infarction, Heart Failure, Disease-Free Survival, Blood Pressure, Fibrinolytic Agents, Tissue Plasminogen Activator, Coronary Artery Bypass
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