Long-term survival benefits of thrombolysis

the Royal College of General Practitioners' myocardial infarction study

Kenneth M Gilmour, Lisa Iversen, Philip C Hannaford

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.
Original languageEnglish
Pages (from-to)192-197
Number of pages6
JournalFamily Practice
Volume32
Issue number2
Early online date24 Feb 2015
DOIs
Publication statusPublished - Apr 2015

Fingerprint

General Practitioners
Myocardial Infarction
Confidence Intervals
Percutaneous Coronary Intervention
Mortality
Needles
Cohort Studies

Keywords

  • follow-up studies
  • general practice
  • myocardial infarction
  • pre-hospital care
  • thrombolysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Long-term survival benefits of thrombolysis : the Royal College of General Practitioners' myocardial infarction study. / Gilmour, Kenneth M; Iversen, Lisa; Hannaford, Philip C.

In: Family Practice, Vol. 32, No. 2, 04.2015, p. 192-197.

Research output: Contribution to journalArticle

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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.",
keywords = "follow-up studies, general practice, myocardial infarction, pre-hospital care, thrombolysis",
author = "Gilmour, {Kenneth M} and Lisa Iversen and Hannaford, {Philip C}",
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 notifications",
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T2 - the Royal College of General Practitioners' myocardial infarction study

AU - Gilmour, Kenneth M

AU - Iversen, Lisa

AU - Hannaford, Philip C

N1 - 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 notifications

PY - 2015/4

Y1 - 2015/4

N2 - 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.

AB - 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.

KW - follow-up studies

KW - general practice

KW - myocardial infarction

KW - pre-hospital care

KW - thrombolysis

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DO - 10.1093/fampra/cmv006

M3 - Article

VL - 32

SP - 192

EP - 197

JO - Family Practice

JF - Family Practice

SN - 0263-2136

IS - 2

ER -