725-2 Long Term Outcome After Early Prehospital Initiated Thrombolysis

Abstract

In order to determine the long-term effects of very early thrombolytic treatment on outcome after myocardial infarction. patients (pts) in the MITI prehospital thrombolysis trial were assessed for cardiac events (death. admission for angina, myocardial infarction. congestive heart failure, revascularization) during a mean period of 33 months follow-up. Outcome in 175 prehospital treated pts (PH-group) was compared to 185 pts allocated to treatment after hospital arrival (H-group). The median time from symptom onset to treatment for the PH-group was 77 min. (56, 101; 25. 75th percentile). and forthe H-groupwas 110 min. (85,140). Survival at two years was 89% forthe PH-group and 91% forthe H-group (p = 0.46). Event free survival at two years was 51% and 60%, respectively Ip = 0.69). The event rate (# events/100 treated pts/follow-up year) was 34.2 in the PH-group and 41.0 for the H-group (p = 0.28). Pts treated within 70 min. after symptom onset (n = 82) had improved survival at the time of discharge. 98.8% vs. 91.3%, but in a multi-variate analysis. subsequent mortality after discharge was related to older age. a history of heart failure, or prior bypass surgery but not initial time to treatment. In the MITI prehospital trial, the short and long-term outcome for pts receiving pre-hospital and hospital initiated thrombolyses is similar. Time to treatment is an important predictor of hospital mortality but does not affect the likelihood of survival in the years after discharge.