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Cochrane corner: prehospital versus in-hospital thrombolysis for ST-elevation myocardial infarction
  1. Michael McCaul1,
  2. Andrit Lourens2,
  3. Tamara Kredo3
  1. 1Centre for Evidence-Based Health Care, Stellenbosch University, Cape Town, Western Cape, South Africa
  2. 2Division of Emergency Medicine, Stellenbosch University, Cape Town, Western Cape, South Africa
  3. 3Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
  1. Correspondence to Dr Michael McCaul, Centre for Evidence-Based Health Care, Stellenbosch University, Cape Town, Western Cape, PO Box 241, Cape Town, 8000, South Africa; mmccaul{at}sun.ac.za

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The WHO reports that cardiovascular disease is the leading cause of death worldwide, with >80% of these deaths occurring in lower-income and middle-income countries (LMICs).1 ST-elevation myocardial infarction (STEMI) can be treated either with percutaneous coronary interventions (PCIs) or thrombolytic agents, which are most effective if given in the first few minutes to hours after onset of symptoms. While traditionally thrombolysis is given in-hospital, prehospital thrombolysis is proposed as an effective intervention to save time and reduce mortality and morbidity in individuals with STEMI. Despite some evidence that prehospital thrombolysis may be delivered safely, there is a paucity of data from controlled trials to indicate whether the timing of delivery can be effective in reducing key clinical outcomes specifically in STEMI in LMICs.

In this Cochrane Corner, we highlight a Cochrane review2 that assessed the effect of prehospital compared with in-hospital thrombolysis for STEMI. A comprehensive search conducted in June 2014 …

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