Efficacy and Safety of Thrombolysis with Intravenous Streptokinase Initiated Prior to Ambulance Transport from Community Hospital to Tertiary Health Care Center

We studied the safety and efficacy of thrombolytic therapy for acute myocardial infarction initiated prior to ambulance transport. Two treatment regimens were compared in a prospective design: 40 patients (group A) received intravenous streptokinase 5 ± 10⁵ IU (SK-IV) prior to and during ambulance transport and were compared with 36 patients (group B) in whom the same dosage of streptokinase was given after arrival in our hospital. In all patients immediate coronary angiography was performed, followed by intracoronary streptokinase administration. Infarct size was assessed by cumulative release of α-hydroxybutyrate dehydrogenase. Apart from three episodes of ventricular fibrillation no procedure-related complications occurred during transport. Median time to SK-IV was 70 minutes in group A versus 125 minutes in group B (P < 0.001). At first visualization the infarct-related vessel was patent in 23 patients (58%) in group A and in 6 patients (17%) in group B (P < 0.001). Anterior wall infarction median infarct size in group A was 32% smaller than that in group B (P < 0.05). We conclude that SK-IV started before ambulance transport is safe, accelerates early reperfusion rate, and consequently leads to a further limitation of infarct size in patients with anterior wall infarction. (J Interven Cardiol 1989:2:3)