Objectives: This 2 phase prospective and controlled trial examines the practicality, benefit and safety of paramedic administration of thrombolytic therapy. We will determine whether paramedics can select appropriate candidates for thrombolytic therapy and if pre-hospital thrombolytic therapy results in greater preservation of left ventricular myocardium than when treatment is initiated in hospital. A registry of all patients hospitalized with acute myocardial infarction will determine the proportion seeking paramedic care and what if any basic clinical differences exist between these patients and those arriving at hospital by other means in order to put the findings in the trial in perspective. Rationale: There is a growing concensus that the sooner coronary revascularization is effected following thrombolytic occlusion, the higher the resultant ejection fraction and lower the mortality. The safety and benefit of prehospital administration of thrombolytic treatment is unknown. Design: 1. The initial phase will examine whether paramedics can identify appropriate candidates for thrombolysis. 2. During the second phase, prehospital patients meeting the case definition (history and physical exam and ECG criteria) will be considered for thrombolytic therapy. Half will receive rt-PA initiated by paramedics and half will have the diagnostic information forwarded to the receiving hospital and treatment will be initiated there. Ejection fraction and myocardial perfusion defect size will be determined in both groups. Clinical histories, outcome and complication rates will be determined. A myocardial infarction registry will tabulate the proportion seeking paramedic care, and compare basic clinical findings in paramedic treated patients with those arriving at hospital by other means.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL038454-03
Application #
3354740
Study Section
Clinical Trials Review Committee (CLTR)
Project Start
1988-04-01
Project End
1991-03-31
Budget Start
1990-04-01
Budget End
1991-03-31
Support Year
3
Fiscal Year
1990
Total Cost
Indirect Cost
Name
University of Washington
Department
Type
Schools of Medicine
DUNS #
135646524
City
Seattle
State
WA
Country
United States
Zip Code
98195
Levy, W C; Cerqueira, M D; Weaver, W D et al. (2001) Early patency of the infarct-related artery after myocardial infarction preserves diastolic filling. Am J Cardiol 87:955-8; A3
Every, N R; Hlatky, M A; McDonald, K M et al. (1998) Estimating the proportion of post-myocardial infarction patients who may benefit from prophylactic implantable defibrillator placement from analysis of the CAST registry. Cardiac Arrhythmia Suppression Trial. Am J Cardiol 82:683-5, A8
Kudenchuk, P J; Maynard, C; Cobb, L A et al. (1998) Utility of the prehospital electrocardiogram in diagnosing acute coronary syndromes: the Myocardial Infarction Triage and Intervention (MITI) Project. J Am Coll Cardiol 32:17-27
Every, N R; Parsons, L; Hlatky, M A et al. (1997) Use and accuracy of state death certificates for classification of sudden cardiac deaths in high-risk populations. Am Heart J 134:1129-32
Magid, D J; Koepsell, T D; Every, N R et al. (1997) Absence of association between insurance copayments and delays in seeking emergency care among patients with myocardial infarction. N Engl J Med 336:1722-9
Every, N R; Parsons, L S; Fihn, S D et al. (1997) Long-term outcome in acute myocardial infarction patients admitted to hospitals with and without on-site cardiac catheterization facilities. MITI Investigators. Myocardial Infarction Triage and Intervention. Circulation 96:1770-5
Every, N R; Parsons, L S; Hlatky, M et al. (1996) A comparison of thrombolytic therapy with primary coronary angioplasty for acute myocardial infarction. Myocardial Infarction Triage and Intervention Investigators. N Engl J Med 335:1253-60
Every, N R; Spertus, J; Fihn, S D et al. (1996) Length of hospital stay after acute myocardial infarction in the Myocardial Infarction Triage and Intervention (MITI) Project registry. J Am Coll Cardiol 28:287-93
Raitt, M H; Maynard, C; Wagner, G S et al. (1996) Relation between symptom duration before thrombolytic therapy and final myocardial infarct size. Circulation 93:48-53
Every, N R; Maynard, C; Cochran, R P et al. (1996) Characteristics, management, and outcome of patients with acute myocardial infarction treated with bypass surgery. Myocardial Infarction Triage and Intervention Investigators. Circulation 94:II81-6

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