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The impact of pre-hospital thrombolytic treatment on re-infarction rates: analysis of the Myocardial Infarction National Audit Project (MINAP).
  1. Simon Horne
  1. Royal Cornwall Hospital, Truro, United Kingdom
    1. Clive Weston (c.f.m.weston{at}swansea.ac.uk)
    1. University of Wales, Swansea, United Kingdom
      1. Tom Quinn
      1. Coventry University, Coventry, United Kingdom
        1. Anne Hicks
        1. Derriford Hospital, Plymouth, United Kingdom
          1. Lynne Walker
          1. University College London, United Kingdom
            1. Ruoling Chen
            1. University College London, United Kingdom
              1. John Birkhead
              1. University College London, United Kingdom

                Abstract

                Objective To examine the frequency and determinants of re-infarction after thrombolytic treatment of ST-elevation myocardial infarction (STEMI).

                Design Observational study of national registry.

                Settings Emergency ambulance services and admitting hospitals in England and Wales.

                Patients 35356 cases of STEMI given thrombolytic treatment in 2005-6.

                Main outcome measures Re-infarction during hospital admission

                Results For 22391 (63.3%) the presence or absence of re-infarction was recorded, and 1460 (6.5%) had re-infarction. Re-infarction rates with in-hospital treatment were similar for reteplase (6.5%) and tenecteplase (6.4%). When the interval from pre-hospital treatment to hospital arrival was greater than 30 minutes re-infarction rates were 12.5% for reteplase, and 11.4% for tenecteplase. Overall, re-infarction rates were higher after pre-hospital treatment with tenecteplase than reteplase (9.6% vs. 6.6%, p = 0.005).<BR> After multivariate analysis independent predictors of re-infarction for tenecteplase were pre-hospital treatment, OR 1.44 (95% CI 1.21 to 1.71, p < 0.001) and weight in the highest quartile compared to the lowest, OR 1.66 (95% CI 1.19 to 2.31, p = 0.003). For reteplase neither factor predicted re-infarction.<BR> Bleeding was less common with pre-hospital treatment - overall 1.8% against 3.1%; intra-cerebral bleeding 0.4% against 0.7%.

                Conclusion Pre-hospital treatment with tenecteplase was associated with higher re-infarction rates. Longer intervals from pre-hospital treatment to arrival in hospital were associated with high re-infarction rates for both tenecteplase and reteplase. Differences in the use of adjunctive anti-thrombotic therapy in the two treatment environments may underlie the differences in re-infarction rates and bleeding complications observed between pre-hospital and in-hospital thrombolytic treatment.

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