Paramedic-Administered Fibrinolysis in Older Patients with Prehospital ST-Segment Elevation Myocardial Infarction.

IF 2.1 3区 医学 Q2 EMERGENCY MEDICINE
Tan N Doan, Robert Ley Greaves, Daniel Bodnar, Brendan V Schultz, Stephen Rashford
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引用次数: 0

Abstract

Objectives: Emergency ambulance services are an essential component of rapid treatment of prehospital ST-segment elevation myocardial infarction (STEMI). The effectiveness and safety of prehospital fibrinolysis in older STEMI patients is unknown. This study investigated the effectiveness and safety of paramedic-administered prehospital fibrinolysis in STEMI patients ≥75 years of age who were identified by paramedics in Queensland, Australia.

Methods: Included were STEMI patients ≥75 years of age who were identified by paramedics in Queensland (Australia), and received prehospital fibrinolysis with tenecteplase or did not receive this treatment due to age being the sole contraindication, between 2010 and 2023. Patient characteristics, outcomes, and safety profiles were compared between the two groups, as well as between patients receiving full-dose and half-dose of tenecteplase.

Results: In total, 86 patients received prehospital fibrinolysis and 83 did not. Patients receiving prehospital fibrinolysis were slightly younger (median 77 vs 81 years, p < 0.001). There was no statistically significant difference in mortality rates at 24 h (risk difference [RD] prehospital fibrinolysis vs no prehospital fibrinolysis 2.1%, 95% confidence interval [CI] - 5.6 to 9.8%, p = 0.41), 30 days (RD -0.3%, 95% CI -9.6 to 9.0%, p = 0.58), and one year (RD -1.7%, 95% CI -12.1 to 8.7%, p = 0.46) between the two groups. There was no statistically significant difference in functional outcomes on discharge (RD for favorable functional outcome 8.8%, 95% CI -6.0 to 23.6%, p = 0.25). No intracranial or major non-intracranial hemorrhage was observed in the entire study sample. Patients receiving full-dose tenecteplase were younger, closer to a hospital capable of percutaneous coronary intervention, in metropolitan areas, and had shorter time from symptom onset to tenecteplase than those receiving half-dose.

Conclusions: This study was the first that investigated the effectiveness and safety of paramedic-administered fibrinolysis in older patients with STEMI. No intracranial or major non-intracranial hemorrhage was recorded for the study sample. There was no association between prehospital fibrinolysis and mortality or functional outcomes.

院前st段抬高型心肌梗死老年患者的护理辅助纤溶治疗
目的:急诊救护服务是院前st段抬高型心肌梗死(STEMI)快速治疗的重要组成部分。院前纤溶治疗老年STEMI患者的有效性和安全性尚不清楚。本研究调查了在澳大利亚昆士兰州由护理人员确定的≥75岁STEMI患者中护理人员给予院前纤溶的有效性和安全性。方法:纳入2010年至2023年期间由澳大利亚昆士兰州医护人员确定的≥75岁的STEMI患者,这些患者院前接受了tenecteplase纤溶治疗,或因年龄是唯一禁忌症而未接受该治疗。比较两组患者的特征、结局和安全性,以及接受全剂量和半剂量tenecteplase的患者。结果:院前接受纤溶治疗86例,未接受纤溶治疗83例。两组接受院前纤溶的患者年龄稍轻(中位77岁对81岁,p p = 0.41), 30天(RD -0.3%, 95% CI -9.6 ~ 9.0%, p = 0.58), 1年(RD -1.7%, 95% CI -12.1 ~ 8.7%, p = 0.46)。出院时的功能结局无统计学差异(功能结局良好的RD为8.8%,95% CI为-6.0 ~ 23.6%,p = 0.25)。在整个研究样本中未观察到颅内或主要非颅内出血。接受全剂量替奈普酶治疗的患者更年轻,离能够经皮冠状动脉介入治疗的医院更近,在大城市,从症状出现到使用替奈普酶的时间比接受半剂量的患者更短。结论:该研究首次调查了护理人员给予老年STEMI患者纤溶治疗的有效性和安全性。研究样本中没有颅内出血或重大非颅内出血的记录。院前纤维蛋白溶解与死亡率或功能结局没有关联。
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来源期刊
Prehospital Emergency Care
Prehospital Emergency Care 医学-公共卫生、环境卫生与职业卫生
CiteScore
4.30
自引率
12.50%
发文量
137
审稿时长
1 months
期刊介绍: Prehospital Emergency Care publishes peer-reviewed information relevant to the practice, educational advancement, and investigation of prehospital emergency care, including the following types of articles: Special Contributions - Original Articles - Education and Practice - Preliminary Reports - Case Conferences - Position Papers - Collective Reviews - Editorials - Letters to the Editor - Media Reviews.
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