Abstract
Objective. To investigate whether there is a long-term survival benefit from receipt of thrombolysis in routine care particularly pre-hospital thrombolysis, using 20 year mortality data from the RCGP myocardial infarction (MI) cohort study.
Methods. During 1991–92 the RCGP MI study assessed GP delivery of thrombolysis. Participants who received pre-hospital thrombolysis (n = 290), thrombolysis in hospital (n = 781) or no thrombolysis (n = 2021) were followed and mortality data collected to June 2012. The relationship between thrombolysis and survival time was analysed using Cox regression at 28 days, 1, 5, 10, 15 years post-AMI, and at end of follow-up (~20 years post-AMI).
Results. Compared to those who did not receive it, participants who received thrombolysis had a significant survival benefit at 28 days [adjusted hazard ratio (HR) 0.72, 95% confidence interval (CI): 0.58–0.90]; 1 year (adjusted HR 0.69, 95% CI: 0.57–0.83); 5 years (adjusted HR 0.76, 95% CI: 0.66–0.86); 10 years (adjusted HR 0.85, 95% CI: 0.77–0.95) and 15 years (adjusted HR 0.88, 95%
CI: 0.80–0.96) post-AMI until end of follow-up (adjusted HR 0.92, 95% CI: 0.84–1.00). Pre versus in-hospital thrombolysis did not appear beneficial, although there was evidence among the prehospital group that short symptom onset-to-needle times conferred greater benefit.
Conclusions. We found substantial long-term survival benefits associated with thrombolysis when used in routine care. Although primary percutaneous coronary intervention (pPCI) is now the choice treatment, thrombolysis remains an important option when pPCI cannot be delivered within 120 minutes of diagnosis.
Methods. During 1991–92 the RCGP MI study assessed GP delivery of thrombolysis. Participants who received pre-hospital thrombolysis (n = 290), thrombolysis in hospital (n = 781) or no thrombolysis (n = 2021) were followed and mortality data collected to June 2012. The relationship between thrombolysis and survival time was analysed using Cox regression at 28 days, 1, 5, 10, 15 years post-AMI, and at end of follow-up (~20 years post-AMI).
Results. Compared to those who did not receive it, participants who received thrombolysis had a significant survival benefit at 28 days [adjusted hazard ratio (HR) 0.72, 95% confidence interval (CI): 0.58–0.90]; 1 year (adjusted HR 0.69, 95% CI: 0.57–0.83); 5 years (adjusted HR 0.76, 95% CI: 0.66–0.86); 10 years (adjusted HR 0.85, 95% CI: 0.77–0.95) and 15 years (adjusted HR 0.88, 95%
CI: 0.80–0.96) post-AMI until end of follow-up (adjusted HR 0.92, 95% CI: 0.84–1.00). Pre versus in-hospital thrombolysis did not appear beneficial, although there was evidence among the prehospital group that short symptom onset-to-needle times conferred greater benefit.
Conclusions. We found substantial long-term survival benefits associated with thrombolysis when used in routine care. Although primary percutaneous coronary intervention (pPCI) is now the choice treatment, thrombolysis remains an important option when pPCI cannot be delivered within 120 minutes of diagnosis.
| Original language | English |
|---|---|
| Pages (from-to) | 192-197 |
| Number of pages | 6 |
| Journal | Family Practice |
| Volume | 32 |
| Issue number | 2 |
| Early online date | 24 Feb 2015 |
| DOIs | |
| Publication status | Published - Apr 2015 |
Bibliographical note
Funding: The original RCGP MI study was funded by SmithKline Beecham through an unconditional research grant. The company have not had access to the data or been involved in its analysis or interpretation. The University of Aberdeen has provided support for maintenance of the database and death notificationsKeywords
- follow-up studies
- general practice
- myocardial infarction
- pre-hospital care
- thrombolysis