What does this research mean for the field?

Pre-hospital administration of thrombolytic therapy with alteplase or streptokinase for extensive myocardial infarction is safe, feasible, and yields superior long-term survival compared to in-hospital treatment. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate the safety, practicality, and long-term outcomes of pre-hospital thrombolytic therapy using alteplase and streptokinase.

May 29, 2026European Heart JournalOpen Access

Pre-hospital thrombolytic therapy with either alteplase or streptokinase

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Extensive myocardial infarction (n=768). Intervention: Pre-hospital thrombolytic therapy (alteplase or streptokinase) vs. In-hospital alteplase (matched group). Primary outcome: Cumulative survival at 5 years.

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Key result

Pre-hospital thrombolysis linked to ~8% higher 5-year survival versus in-hospital treatment.

n=768

Why the study?

To assess the practical application, safety, and long-term outcome of pre-hospital thrombolytic intervention with alteplase or streptokinase in extensive myocardial infarction.

Does pre-hospital thrombolytic therapy with alteplase or streptokinase improve survival and safety in patients with extensive evolving myocardial infarction compared to in-hospital treatment?

Key Points

This study aims to evaluate the safety, practicality, and long-term outcomes of pre-hospital thrombolytic therapy using alteplase and streptokinase.
Evaluated patients with chest pain lasting over 30 minutes and evidence of extensive myocardial infarction.
Used a standardized questionnaire for eligibility, assessed by general practitioners or ambulance nurses.
Administered either alteplase or streptokinase, with monitoring through ECG recordings.
529 patients received pre-hospital thrombolytic treatment between 1988-1993, with a time gain of 50 minutes.
Hospital mortality rate was 2%, 1-year mortality rate was 3%, and cumulative survival after 5 years was 92%.
5-year survival was superior to the 84% observed in a matched group treated with alteplase in hospital.

Study Design

Type

Cohort (n=768)

Structured PICO

Does pre-hospital thrombolytic therapy with alteplase or streptokinase improve survival and safety in patients with extensive evolving myocardial infarction compared to in-hospital treatment?

Population

529 patients with extensive evolving myocardial infarction (chest pain >30 min duration, presenting within 6 h of symptom onset, and sum ST deviation of at least 1.0 mV).

Intervention

Pre-hospital thrombolytic therapy initiated in the ambulance (100 mg alteplase [n=246], 50 mg alteplase followed by 0.75 x 10^6 IE streptokinase in hospital [n=90], or 1.5 x 10^6 IE streptokinase intravenously [n=193]).

Comparator

Matched group of 239 patients with similar baseline characteristics treated with alteplase in hospital.

Outcome

Death and life-threatening complications (ventricular fibrillation, cardiac arrest) and side effects (hypotension, allergic reactions) during transportation to hospital and in the first 24 h following hospitalization, and survival up to 5 years follow-up.hard clinical

Main Result

Absolute Event Rate: 92% vs 84%

Pre-hospital administration of thrombolytics for extensive myocardial infarction is safe, saves approximately 50 minutes, and is associated with excellent long-term survival compared to in-hospital administration.

Discussion

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Implication

Feasibility of pre-hospital thrombolysis shown in extensive MI; leaves open its role versus modern reperfusion.

Cite This Study

Grijseels et al. (1995) conducted a cohort in Extensive myocardial infarction (n=768). Pre-hospital thrombolytic therapy (alteplase or streptokinase) vs. In-hospital alteplase (matched group) was evaluated on Cumulative survival at 5 years. Pre-hospital administration of thrombolytic therapy resulted in a 5-year cumulative survival of 92%, which was superior to 84% in a matched in-hospital treatment group.

synapsesocial.com/papers/6a1a02c99dc5faccca0f4a09 https://doi.org/10.1093/oxfordjournals.eurheartj.a060836

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Pre-hospital thrombolytic therapy with either alteplase or streptokinase

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Pre-hospital thrombolytic therapy with either alteplase or streptokinase

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

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