ELSEVIER International Journal of Cardiology 49 (Suppl.) (1995) S21-S28 International eb.lrnalof CARDIOLOOY Early intravenous thrombolysis in acute myocardial infarction: the Jerusalem experience Y. Rozenman*, M.S. Gotsman, A.T. Weiss, C. Lotan, M. Mosseri, D. Sapoznikov, S. Welber, Y. Hasin, D. Gilon Department of Cardiology, Hadassah University Hospital; P.O. Box 12000, Ein Kerem, Jerusalem, Israel 91120 Abstract Myocardial damage in acute myocardial infarction is a time-dependent process. We examined the influence ofvery early thrombolytic therapy, comparing prehospital to hospital administration, in a consecutive group of patients with myocardial infarction on mortality, complications and the preservation of left ventricular function. Seven hundred sixty patients received early thrombolytic therapy: 114 at home (time delay to treatment 1.4 ± 0.8 h) and 646 in hospital (2.1 ± 1.0 h). Sixteen patients died in hospital and significant hemorrhage occurred in 15 (including three patients with hemorrhagic stroke). There was no difference between groups in hospital mortality or rate of complications. The duration of ischemia was shorter in patients with prehospital therapy (pain duration: 3.3 ± 2.1 vs. 4.0 ± 2.2; P < 0.05, and time to recovery of the ST segment in the electrocardiogram: 4.3 ± 3.3 vs, 6.6 ± 6.3; P < 0.cXl2). Peak plasma creatine kinase was earlier in patients with prehospital therapy (11.2 ± 5.0 vs. 13.0 ± 5.8; P < 0.002), although there was no difference between groups in the absolute peak plasma level. Left ventricular function was assessed by contrast ventriculography 1 week after admission (616 patients). Ventricular function was better in patients with prehospital therapy: (ejection fraction of 58 ± 13% vs. 54 ± 15%; P < 0.05 and a left ventricular dysfunction index of 534 ± 515 vs. 691 ± 519 units; P < 0.05). We conclude that prehospital thrombolytic therapy is feasible and safe. Reperfusion is achieved earlier and more myocardium can be salvaged using this strategy without increasing the rate of complications. Keywords: Thrombolysis; Myocardial infarction; Home; Time delay; Ventricular function 1. Introduction Acute myocardial infarction is the major killer in our modem civilized Western society. Hospital mortality was 32% in the 1960s [1], and has fallen • Corresponding author. to 14% since the introduction of coronary inten• sive care units [2,3]. Reperfusion therapy, which aims at decreasing infarct size, has further re• duced the mortality to very low levels of 4-8% in selected subsets of patients [4-10]. Complete occlusion of a coronary artery with a balloon causes ischemia with decrease in myocar• dial relaxation and contraction within 20 s, ST 0167-5273/95/$09.50 1995 Elsevier Science Ireland Ltd. All rights reserved SSDI 0167·5273(95) 0233S-T