Document Detail

Magnitude of benefit from earlier thrombolytic treatment in acute myocardial infarction: new evidence from Grampian region early anistreplase trial (GREAT)
MedLine Citation:
PMID:  8563585     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To generalise from the results of the Grampian region early anistreplase trial (GREAT) and to express the benefit of earlier thrombolysis in terms of lives saved per hour of earlier treatment. DESIGN: Multivariate analysis of a randomised double blind trial. SETTING: 29 rural practices in Grampian region and teaching hospitals in Aberdeen. SUBJECTS: 311 patients with suspected acute myocardial infarction and without contraindications to thrombolysis who were seen by their general practitioners within four hours of the start of symptoms. INTERVENTIONS: Anisterplase 30 units given intravenously, either by general practitioners before hospitalisation or later in hospital. MAIN OUTCOME MEASURE: Death within 30 months of entry into trial. RESULTS: Death within 30 months was positively related to age (P < 0.0001) and to delay between start of symptoms and thrombolytic treatment (P = 0.0004). However, the probability of dying rose exponentially with earlier presentation, so death within 30 months was negatively related to the logarithm of the time of randomisation (P = 0.0163). In patients presenting two hours after start of symptoms each hour's delay in receiving thrombolysis led to the loss of 21 lives per 1000 within 30 days (95% confidence interval 1 to 94 lives per 1000) (P = 0.03) and 69 lives per 1000 within 30 months (16 to 141 lives per 1000) (P = 0.0004). CONCLUSIONS: The magnitude of the benefit from earlier thrombolysis is such that giving thrombolytic treatment to patients with acute myocardial infarction should be accorded the same degree of urgency as the treatment of cardiac arrest.
J Rawles
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  BMJ (Clinical research ed.)     Volume:  312     ISSN:  0959-8138     ISO Abbreviation:  BMJ     Publication Date:  1996 Jan 
Date Detail:
Created Date:  1996-03-06     Completed Date:  1996-03-06     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8900488     Medline TA:  BMJ     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  212-5     Citation Subset:  AIM; IM    
Medicines Assessment Research Unit, University of Aberdeen.
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MeSH Terms
Anistreplase / therapeutic use*
Emergency Medical Services
Family Practice
Fibrinolytic Agents / therapeutic use*
Follow-Up Studies
Logistic Models
Middle Aged
Multivariate Analysis
Myocardial Infarction / drug therapy*,  mortality
Patient Acceptance of Health Care
Rural Health
Survival Rate
Thrombolytic Therapy / methods*
Time Factors
Treatment Outcome
Reg. No./Substance:
0/Fibrinolytic Agents; 81669-57-0/Anistreplase
Comment In:
BMJ. 1996 Jan 27;312(7025):215-6   [PMID:  8563586 ]
ACP J Club. 1996 Jul-Aug;125(1):6

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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