[Combination of prehospital systemic thrombolytic therapy with endovascular procedures in the treatment of patients with acute myocardial infarction].

Since July 2002 we have been conducting a study of efficacy of prehospital thrombolytic therapy combined with subsequent endovascular procedures in the treatment of patients with acute myocardial infarction. Fifty nine patients received prehospital fibrinolysis with tissue-type plasminogen activator (TPA, n=28) or streptokinase (n=31) within 6 hours after onset of symptoms. TPA infusion compared with that of streptokinase was associated with smaller ischemic myocardial damage and lower frequency of side effects (3.6 and 38.7%, respectively). Angioplasty or stenting of infarct related arteries were carried out in 47 of these patients. The group of patients subjected to endovascular interventions was characterized by a low rate of in-hospital cardiac events and zero mortality.

[The clinical aspects of using thrombolytic therapy in myocardial infarct at the prehospital stage]. / Klinicheskie aspekty primeneniia tromboliticheskoi terapii pri infarkte miokarda na dogospital'nom étape.

The examination of 80 patients with acute myocardial infarction has revealed that prehospital thrombolytic therapy (TT) allows it to be initiated significantly earlier by 2.9 hours, resulting in coronary reperfusion and ensuring more complete blood flow recovery than hospital therapy. The natural history of the disease is also more favourable when TT is used in the prehospital period. It is concluded that with strict observance of indications and contraindications, TT used by an emergency team in the prehospital period is no more dangerous than in the hospital period.

[Thrombolytic treatment of myocardial infarction at the prehospital and hospital stage]. / Tromboliticheskaia terapiia pri infarkte miokarda na dogospital'nom i statsionarnom étapakh.

Thrombolytic therapy was performed in 59 patients within the first hours of myocardial infarction. Twenty three patients (Group 1) were given streptokinase (SK) by an emergency team, 36 patients (Group 2) received SK following coronary angiography. In Group 1, SK was initiated earlier (p less than 0.001) than in Group 2. In Group 1 there was no coronary artery occlusion in the appropriate site of myocardial infarction in 86% of the patients. In Group 2, coronary occlusion was detected in 88% reperfusion, in 50% of the cases. Severe overall and regional left ventricular contractility abnormalities were found within the first month of the disease. The incidence of complications is the same in the two groups. High efficiency and relatively safe of thrombolytic therapy in the prehospital period makes this method particularly promising for practical medicine.