Pre‐hospital Thrombolysis for ST‐segment Elevation Myocardial Infarction in Regional Australia: Long Term Follow Up

BACKGROUND: Delivering reperfusion therapy to patients with ST-segment elevation myocardial infarction (STEMI) in regional areas without access to tertiary cardiology care remains challenging. The systems of care in Hunter New England Health, NSW Australia (Area covered = 130, 000 square kilometres) to provide reperfusion to patients with STEMI involve a 12-lead electrocardiogram in the ambulance, discussion between cardiologist and paramedic, followed by prehospital thrombolysis (PHT) delivered in ambulance to appropriate patients > 60 minutes from the CCL. Patients who can access the CCL within 60 minutes are treated with primary percutaneous coronary intervention (PCI). We have previously reported excellent 12-month outcomes for patients receiving PHT. Whether these outcomes are sustained in the longer term remains unknown. METHODS: We assessed long term all-cause mortality and major adverse cardiovascular events of STEMI patients undergoing PHT in our health district from August 2008 to August 2013 and compared with the primary PCI group. RESULTS: One hundred and fifty patients (mean age: 62±13 years, Males: 76%, n=114) were administered PHT and 334 patients (mean age: 65±13 years, Males: 75 %, n=251) underwent primary PCI during the study period. During a median follow up of 6.2 years (IQR: 4.8 - 7.4 years) all-cause mortality was 16% and 19% in the PHT and primary PCI groups respectively (P: 0.4). CONCLUSION: Our real-world experience shows that PHT followed by early transfer to a primary PCI-capable centre is an effective reperfusion strategy, with comparable results to primary PCI, and mortality benefits are sustained to more than 6 years. This article is protected by copyright. All rights reserved.