The case for prehospital thrombolysis in acute myocardial infarction

Thrombolysis is of proven benefit in improving survival after acute myocardial infarction. The benefit decreases with time after the onset of pain; the first 2 h appear to be important. Reduction of thrombolysis times must be undertaken as a whole‐systems approach. Delays in the patient contacting assistance services are unavoidable, but once contact is made the system should ensure attendance of a qualified person within 8 min. In‐hospital delays should be decreased, aiming for a door‐to‐needle time of less than 30 min. Prehospital electrocardiographs are accurate and can help reduce in‐hospital delays. Some trials have shown that prehospital administration of thrombolysis can lead to reduced thrombolysis times. Angioplasty with or without stenting for those with contraindications to thrombolysis and as a rescue procedure needs to be considered in deciding the destination of AMI patients. More evidence is needed to support this aspect of care. Prehospital thrombolysis has an important role to play, especially when time to hospital may be prolonged.