Key result
Prehospital fibrinolysis for STEMI was associated with a 3% 30-day mortality rate, which did not significantly differ from ED fibrinolysis (6%), EMS to PCI (2%), or ED to PCI (4%) (P=0.28).
Why the study?
Nova Scotia incorporated recommended EMS interventions including prehospital fibrinolysis and direct PCI bypass into a province-wide STEMI approach, but comparative 30-day mortality outcomes across these reperfusion strategies needed evaluation.
Does prehospital or emergency department fibrinolysis compared to primary PCI affect 30-day mortality in STEMI patients?
Cohort (n=1,071)
Yes
Does prehospital or emergency department fibrinolysis compared to primary PCI affect 30-day mortality in STEMI patients?
p-value: p=0.28
Prehospital fibrinolysis is a feasible reperfusion strategy for STEMI with comparable 30-day mortality to primary PCI in a province-wide system.
Comparable mortality with prehospital fibrinolysis does not support practice change; leaves open need for randomized confirmation versus PCI.
BACKGROUND: Fibrinolysis is an acceptable treatment for acute ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be performed within 120 minutes. The American Heart Association has recommended Emergency Medical Services (EMS) interventions such as prehospital fibrinolysis (PHF), prehospital electrocardiogram (ECG), and hospital bypass direct to PCI center. Nova Scotia, Canada has incorporated these interventions into a unique province-wide approach to STEMI care. A retrospective cohort analysis comparing the primary outcome of 30-day mortality for patients receiving either prehospital or emergency department (ED) fibrinolysis (EDF) to patients transported directly by EMS from community or regional ED for primary PCI was conducted. METHODS: This retrospective, population-based cohort study included all STEMI patients in Nova Scotia who survived to hospital admission from July 2011 through July 2013. Three provincial databases were used to collect demographic, 30-day mortality, hospital readmission, and rescue PCI data. The results were grouped and compared according to reperfusion strategy received: PHF, EDF, patients brought by ambulance via EMS direct to PCI (EMS to PCI), and ED to PCI (ED to PCI). RESULTS: There were 1,071 STEMI patients included with 145 PHF, 606 EDF, 98 EMS to PCI, and 222 ED to PCI. There were no significant differences in 30-day mortality across groups (n, %): PHF 5(3); EDF 36(6); EHS to PCI <5(2); and ED to PCI 10(4); P = .28. There was no significant difference in patients receiving fibrinolysis who underwent rescue PCI. CONCLUSIONS: Prehospital fibrinolysis incorporated into a province-wide approach to STEMI treatment is feasible with no observed difference in patient 30-day mortality outcomes observed.
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Cook et al. (2020) conducted a cohort in acute ST-segment elevation myocardial infarction (STEMI) (n=1,071). Prehospital fibrinolysis vs. Emergency department fibrinolysis, EMS to PCI, or ED to PCI was evaluated on 30-day mortality (p=0.28). Prehospital fibrinolysis for STEMI was associated with a 3% 30-day mortality rate, which did not significantly differ from ED fibrinolysis (6%), EMS to PCI (2%), or ED to PCI (4%) (P=0.28).
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