Place de la thrombolyse préhospitalière à la phase aiguë de l'infarctus du myocarde

Abstract

Acute myocardial infarction results from coronary occlusion. Early thrombolysis or angioplasty is the emergency treatment. Studies comparing both techniques of reperfusion did not show significant differences. However, analyses suggest that thrombolysis benefit is associated with early initiation. Prehospital thrombolysis administered by paramedics in ambulances strongly reduces treatment delay. Thus, patients treated within two hours after symptom-onset show a strong trend toward reduced 30-day mortality. This strategy is safe and feasible and highly superior to in-hospital thrombolysis. The comparison between prehospital thrombolysis and primary angioplasty demonstrates the superiority of thrombolysis within the first two hours of symptoms. If reocclusion occurs in spite of thrombolysis, reperfusion can be achieved by urgent percutaneous coronary intervention (PCI). In France, thanks to thrombolysis, Mobile Intensive Care Unit offers equal medical care to population far away from a percutaneous coronary intervention center.