Study Design

Study Design:

Patients Enrolled: 280
Mean Follow Up: 35 days
Mean Patient Age: 50-75
Female: ~30

Patient Populations:

Patients in whom the emergency room physician in the ambulance had a strong clinical suspicion of evolving acute myocardial infarction. Symptoms had to be present for at least 30 minutes, but no more than six hours, and resistant to sublingual nitrates. ECG had to demonstrate upsloping ST segments >2 mm in at least two precordial leads or >1 mm in at least two contiguous peripheral leads. There could be no reduction in pain or ST segments following a second evaluation in the emergency room.

Exclusions:

Thrombolytic therapy during the past six months, surgical or major invasive procedures during the last 10 days, active gastrointestinal (GI) bleeding or a history of GI bleeding during the past six months, stroke or neurosurgical procedure during the previous two months, endocranial aneurysm or tumors, hypocoagulant therapy or hemorrhagic diathesis or thrombocytopenia, proliferative diabetic retinopathy, high likelihood of pregnancy in course or severe vaginal hemorrhage, hypertension greater than 200/100 mm Hg, recent resuscitation with chest compressions >10 minutes, or former enrollment in the study

Primary Endpoints:

Time saving, accuracy of diagnosis, adverse events, left ventricular function, and survival

Drug/Procedures Used:

Patients strongly suspected of having acute myocardial infarction en route to rural hospitals in Israel were treated upon arrival to the rural hospital emergency room. Patients were enrolled in Israel, where ambulances are staffed by emergency room physicians. The ambulance physician transmitted the ECG to a CCU physician to confirm the diagnosis. Patients were treated with anistreplase 30 U via bolus injection over four minutes.

A parallel group of patients was enrolled in the CCU of a city hospital (S. Maria della Croce Hospital in Ravenna). This group received anistreplase on arrival to the city hospital CCU in a similar fashion to the rural patients. Following treatment, the rural patients were transferred to the city hospital CCU for further care.

Concomitant Medications:

Morphine for pain control, lidocaine, and atropine for arrhythmias; diuretics for pulmonary edema; and fluid or vasopressors for hypotension. Specific usage rates for groups were not reported.