Document Detail

Community hospital administration of intravenous tissue plasminogen activator in acute myocardial infarction: improved timing, thrombolytic efficacy and ventricular function.
MedLine Citation:
PMID:  3119685     Owner:  NLM     Status:  MEDLINE    
As an investigational fibrinolytic agent for acute myocardial infarction, intravenous recombinant tissue-type plasminogen activator (rt-PA) has been administered primarily in tertiary care and university centers. To determine the value of early initiation of such therapy, two satellite community hospital emergency rooms were established for use of rt-PA and the experience was compared among 142 consecutive patients who were transferred to a regional center for acute cardiac catheterization after intravenous rt-PA therapy. In Group I (n = 19), patients received rt-PA after interhospital transport to the regional center, but before cardiac catheterization. In Group II (n = 70), rt-PA therapy was initiated by the helicopter physician and nurse team after their arrival at the local community hospital emergency room. Group III patients (n = 53) had rt-PA administered in the local community hospital by the emergency room physician. Group III patients had earlier initiation of therapy (2.1 +/- 0.8 hours in Group III versus 3.8 +/- 1.2 hours in combined Groups I and II, p less than 0.001) and an increased rate of infarct vessel recanalization on the 90 minute coronary angiogram (81 in Group III versus 67% in combined Groups I and II, p = 0.057). The patients in Group III had a higher acute left ventricular ejection fraction (54 +/- 8% versus 50 +/- 9.5% in combined Groups I and II, p less than 0.01) and a trend toward an increased 7 day ejection fraction (55.5 +/- 9% versus 51.7 +/- 9.5%, respectively, p = 0.08).(ABSTRACT TRUNCATED AT 250 WORDS)
E J Topol; E R Bates; J A Walton; G Baumann; S Wolfe; J Maino; L Bayer; L Gorman; E M Kline; W W O'Neill
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  10     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1987 Dec 
Date Detail:
Created Date:  1988-01-12     Completed Date:  1988-01-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1173-7     Citation Subset:  AIM; IM    
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.
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MeSH Terms
Follow-Up Studies
Heart Catheterization
Hospitals, Community*
Infusions, Intravenous
Middle Aged
Myocardial Infarction / drug therapy*,  pathology,  physiopathology
Recombinant Proteins
Stroke Volume
Time Factors
Tissue Plasminogen Activator / administration & dosage,  therapeutic use*
Reg. No./Substance:
0/Recombinant Proteins; EC Plasminogen Activator

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