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Prehospital thrombolysis for STEMI: a strategy for town and country?

David B Brieger
Med J Aust 2011; 195 (3): 157-158.

To the Editor: A review by Harper and Lefkovits favoured increased use of prehospital thrombolysis (PHT) for the management of ST-elevation myocardial infarction (STEMI).1 The acknowledged importance of early reperfusion and the ready application of PHT make this a sound recommendation for settings that are remote from percutaneous coronary intervention (PCI) centres.

David B Brieger, Head of Coronary Care and Coronary Interventions
Concord Repatriation General Hospital, Sydney, NSW.
Article References: 
Reference Text: 
Harper RW, Lefkovits J. Prehospital thrombolysis followed by early angiography and percutaneous coronary intervention where appropriate — an underused strategy for the management of STEMI. Med J Aust 2010; 193: 234-237.
Reference Order: 
1
PubMed ID: 
20712546
Reference Text: 
Bonnefoy E, Steg PG, Boutite F, et al. Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up. Eur Heart J 2009: 30: 1598-1606.
Reference Order: 
2
PubMed ID: 
19429632
Reference Text: 
Steg PG, Bonnefoy E, Chabaud S, et al. Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation 2003; 108: 2851-2856.
Reference Order: 
3
PubMed ID: 
14623806
Reference Text: 
Stenestrand U, Lindbäck J, Wallentin L; RIKS-HIA Registry. Long-term outcome of primary percutaneous coronary intervention vs prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction. JAMA 2006; 296: 1749-1756.
Reference Order: 
4
PubMed ID: 
17032988
Reference Text: 
Ellis SG, Tendera M, de Belder MA, et al. Facilitated PCI in patients with ST-elevation myocardial infarction. N Engl J Med 2008; 358: 2205-2217.
Reference Order: 
5
PubMed ID: 
18499565
Reference Text: 
Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) investigators. Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomised trial. Lancet 2006; 367: 569-578.
Reference Order: 
6
PubMed ID: 
16488800

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