Prehospital fibrinolysis was as good as primary angioplasty after myocardial infarction.

P a t i e n t s 840 patients (median age 58 y, 82% men) with symptoms of MI for ≤ 6 hours. Exclusion criteria were known bleeding disorders or contraindication to fibrinolysis, severe renal or hepatic insufficiency, aortofemoral bypass or hampered femoral artery access, cardiogenic shock, history of coronary artery bypass graft surgery, current oral anticoagulant treatment, or expected duration of hospital transfer > 1 hour. Follow-up data were available for 837 patients (99.6%). I n t e r v e n t i o n All patients received an intravenous (IV) bolus of heparin, 5000 U, and aspirin, 250 to 500 mg, orally or IV. Patients were allocated to primary angioplasty involving immediate transport to the hospital for coronary angiography and angioplasty if needed (n = 421), or to prehospital fibrinolysis with an IV bolus of alteplase, 15 mg, and alteplase infusion, 0.75 mg/kg of body weight for 30 minutes and 0.50 mg/kg for the next 60 minutes (n = 419).