GREAT: 10 year survival of patients with suspected acute myocardial infarction in a randomised comparison of prehospital and hospital thrombolysis.

The Grampian region early anistreplase trial (GREAT) assessed the feasibility, safety, and efficacy of prehospital thrombolysis given by general practitioners. This treatment was shown to be feasible and safe in their hands, and at one year a halving of mortality was reported (p = 0.007). Seven other small randomised trials comparing prehospital with hospital thrombolysis have been published, and although none showed significant benefit at one month, meta-analysis has confirmed the value of prehospital thrombolysis. Standard 6 of the National Service Framework for coronary heart disease requires that thrombolysis should be given within 60 minutes of calling for professional help. Since GREAT has been influential in informing policy decisions and formulating this target, the 10 year results are presented in this paper.