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O34 Thrombolysis after resuscitation in myocardial infarction: Data from “the 60-minutes myocardial infarction project”
Sudden Death, Myocardial Infarction
S28
034
030 PRE
CORONARY
CARE
PREHDSPlTAL
Based
The SECT
data.
Cardiac
derived
prehospital
on e Mobile
cardiac
life suppod
During
two years
cardmc
ongln
the MICU
The SECT
within
two hours.
USMlANl
T
Turin
Italy
from a previous
Care
has camed
72.4%
wfb
chest
time
w+fhi”
In 162 cases (41.4% of soepeded AMI. pw6xmd with a median delay of 75 mm v&hi”
two houn
and 75.3%
27.4%
time
limks
in 24.7%.
femporel
revnew
of a”cIusio”
intrahospital
delay
the hospital The
ovemll
auf-OFhospital
Motiality
less the” 70 years Prehospital dwgned
though
Mea”
8.6%
38.8%
sympfoms
pain
of presumed (11% of a11
AMI wes 67.25 +I-
reached
within
one hour.
onset. chest
pan”) prehospkal
onset
three how.
18,8%
of pfs were
229 pfs were Further
pfs lhmmbolyeis
of pfs were
trained
emergencies
in 381 cases
age of pts with suspned
symptoms
in 24,7%
for chest (AMI)
a
SECn
and a “wee
of all cardiac
(53.5%)
~“fercbo”
of pts with
from
wnhi”
min.
Tenitoriale.
with e physician
1884
myacadial
wes 57.5
cdfeda
excluded
21 pfs were
was performed
fhe “gear up phenomenon”.
rate
of
wes 15.7%’
major
in wehospital
AMI wee 12.3%
treated
old). Low “otiebfy
pw wes 4.3%.
rate I” prehospifal
I” our experience
all Cardm
mmplicefions
15% I” not treated
for pfs with euepecfed
fhrombolysis to treat
and beabne”f
199.2 within
with
I” field
thmmbolys1s treated for age .75
treated
a media”
suepeded
in hospital delay
wes
within
THROMBOLYSIS AFTER RESUSCITATION IN MYOCAROIAL INPARCTtON: DATA FROM “THE SD-MINUTES YYOCARDUL INFARCTtON PROJEClR. SCHIELE, ‘,U BURCZYK, J RUSTIGE, A. KOCH’, J. SENGES Heruentrum Ludwigshafen, Kardiologle, and ZMBT Heidelberg’; for the ALKK Study Group, Germany “The 60-Minutes Myocardial Infarction Project’ is a mu¢er study of the currant treatment of acute myocardial infarction (AMI) in Germany (control phase 1992/93) Methods: In the control phase (8 months), a/l transmural AMI presenting withm the first 96 hours in 154 hospitals in Germany were registered prospectively (n=4710, mean age 65yrs, 69.5% male). This paper evaluates the current usage of thrombolysis after cardiopulmonary resusoitation (CPR). Results: 216 pts. (4 6% of all AMI) received CPR in the prehospital phase und the lntrahospitel acute phase Early mortality (48h) in the CPR group was significantly higher In the nonrandomized CPR subgroups lysis versus no lysis, early mortellty (48h) was 24.1% (lysis) vs 30.7% (no lysis).
one
years
I”
affer
a
of 150 mi”
AMI wes confirmed
by
I” 8B9( of ceses.
anhythmias)
morlality
than SO
: in these
perwe
physician
overelf
lhrealening
criteria
staffed
M
lhrombolysls
in March
Cardiologiche
for diagnosis
six hours fmm
hour. 56.5%
Emergenze
pa”).
AND
CASACCIA
hosplfals
in Tun”
Unit (MICU),
awle
P
on community
was starled
ou1 3523 missKms,
suspected
INFARCTION
SCACCIATELLA
experience
therapy
(Servizio
and equppea
intewentms, 20.7% of petie”ls -pfs 12.8 years (3446). Media” decision 58.7%
M
lnfeneive
MYOCARDIAL
EXPERIENCE
Hasp,tal
System
phywa”
ACUTE
(ITALY)
thrombdyOc
Emergencies
is based
m advanced
SICURD
BanMa
and safety
hterature
comprehensive
F
S.Giavarm
o” feas~bdlty
OF
THE TURlN
A., SERTELLD
D,vis~on
and from
MANAGEMENT
THRDMSDLYSIS.
DE BERNARD, Cardiology
UNlT
Emergencves,
,s feas,Me wth
(Cardiac
Arrest,
with thmmbolyas (8.8%
male,
compared treated
IS%
female),
hypofenslo”, in treated 33.9%
of pfs not treated
lifepts The
in pfs older (12% I” pts
pts IS to be stressed
and safe,
low complicabo”
20.8%
v&h
severe end 4,3%
wifh,”
e” Emerpency
and moltality
Med,ca,
System
Conclusions: CPR In AMI current practice in Germany, Nonrandomized pts receiving CPR have a better short term
is a predictrx of poor short term prognosis. In a third of CPR pts with AMI receive thrombolysis. thrombolysis despite the relative contraindication outcome
rate and “o adfuntiive
MS& acute
myocaldial
lnfarcfio”
prehospital
thmmbolysis
cardiac
emergencies
Cardiopulmonarv
resuscitation.
myocardial
infarction,
thrcxnbolysis
0120 CIRCADIAN VARIATION OF SUDDEN CARDIAC DEATH, DUE TO VtNTRICULAR FIBRILLATION: DOES IT DEPEND ON UNDERLYINQ DtSEASE? H-R.
ARNTZ.
KLINIKUM
032
P. KmInONI,
v. CICLIO. w. ROLLOldI, c. ROSCIO, 1. sP*IIp*"Am A#Il n. PISml.ESE
M. OEFF,
S. N. WILLICH,
T. BRUGGEM,MN.
R. STERN,
DPI.
CARDIowu(oLDGY.,
STEGLITZ.FREEUNIVERSITYBERLIN.HINDEN6URGDAMM30. D-12200BERLIN
The incidence o! sudden cardiac death, due to ventricular iibrlllatii (VF) is characterized by a btphasic circadian distribution wtih a major primary morning and an secondary early evening peak. There is a lack of information on the potenttal influence of underlying disease on this circadian variation. We therefore analyzed 441 consecutive prehospital resuscitation attempts in patients wlh VF, performed by the Berlin Fire Brigade in during the years 1889-1991 in the Klinikum Steglitz area (population about 35O.ooO). VF was documented &her in automated external defibriltators in emergency medical technician-initiated resusoi!ati~s (n&94) or by means of manual defifxillators in patients in whom resuscitation was begun by emergency physicians (n=147; hospital based emergency physicians form the second tier of the two-tiered Berlin EMS-system). Twohundred and sforty (54%) of the patients were successfully resusottated in the field and admltted to hospital alive. In 91 patients an acute myocardiil infarction could be defined as underlying disease (age 64i13 years, 68% male). 99 patients had primary VF (age 7ofll years, 62% male). In the remaining patients the triggering underlying disease could not be established because of early death after hospital admission (n=45). In another five patients VF was tnggered by unusual conditions like severe hypokaliemia or bleeding. The typical circadian variation (ps.001) could bs demonstrated in all VF-patients. and in those beeing admitted to hospital alive as well as in both subgroups with VF caused by acute myocwdiil infarction or primary VF. Younger patients with primary VF had a tendency to a more pronounced afternoon peak compared to younger AMI -patients who showed a more pronounced morning peak of events. Conclusion: The characteristic circadian variation of sudden card& death due to VF remains generally uninfluenced by underlying disease. Circadian variation, ventricular fibrillation, myocardial infarction, sudden death
S28
034
030 PRE
CORONARY
CARE
PREHDSPlTAL
Based
The SECT
data.
Cardiac
derived
prehospital
on e Mobile
cardiac
life suppod
During
two years
cardmc
ongln
the MICU
The SECT
within
two hours.
USMlANl
T
Turin
Italy
from a previous
Care
has camed
72.4%
wfb
chest
time
w+fhi”
In 162 cases (41.4% of soepeded AMI. pw6xmd with a median delay of 75 mm v&hi”
two houn
and 75.3%
27.4%
time
limks
in 24.7%.
femporel
revnew
of a”cIusio”
intrahospital
delay
the hospital The
ovemll
auf-OFhospital
Motiality
less the” 70 years Prehospital dwgned
though
Mea”
8.6%
38.8%
sympfoms
pain
of presumed (11% of a11
AMI wes 67.25 +I-
reached
within
one hour.
onset. chest
pan”) prehospkal
onset
three how.
18,8%
of pfs were
229 pfs were Further
pfs lhmmbolyeis
of pfs were
trained
emergencies
in 381 cases
age of pts with suspned
symptoms
in 24,7%
for chest (AMI)
a
SECn
and a “wee
of all cardiac
(53.5%)
~“fercbo”
of pts with
from
wnhi”
min.
Tenitoriale.
with e physician
1884
myacadial
wes 57.5
cdfeda
excluded
21 pfs were
was performed
fhe “gear up phenomenon”.
rate
of
wes 15.7%’
major
in wehospital
AMI wee 12.3%
treated
old). Low “otiebfy
pw wes 4.3%.
rate I” prehospifal
I” our experience
all Cardm
mmplicefions
15% I” not treated
for pfs with euepecfed
fhrombolysis to treat
and beabne”f
199.2 within
with
I” field
thmmbolys1s treated for age .75
treated
a media”
suepeded
in hospital delay
wes
within
THROMBOLYSIS AFTER RESUSCITATION IN MYOCAROIAL INPARCTtON: DATA FROM “THE SD-MINUTES YYOCARDUL INFARCTtON PROJEClR. SCHIELE, ‘,U BURCZYK, J RUSTIGE, A. KOCH’, J. SENGES Heruentrum Ludwigshafen, Kardiologle, and ZMBT Heidelberg’; for the ALKK Study Group, Germany “The 60-Minutes Myocardial Infarction Project’ is a mu¢er study of the currant treatment of acute myocardial infarction (AMI) in Germany (control phase 1992/93) Methods: In the control phase (8 months), a/l transmural AMI presenting withm the first 96 hours in 154 hospitals in Germany were registered prospectively (n=4710, mean age 65yrs, 69.5% male). This paper evaluates the current usage of thrombolysis after cardiopulmonary resusoitation (CPR). Results: 216 pts. (4 6% of all AMI) received CPR in the prehospital phase und the lntrahospitel acute phase Early mortality (48h) in the CPR group was significantly higher In the nonrandomized CPR subgroups lysis versus no lysis, early mortellty (48h) was 24.1% (lysis) vs 30.7% (no lysis).
one
years
I”
affer
a
of 150 mi”
AMI wes confirmed
by
I” 8B9( of ceses.
anhythmias)
morlality
than SO
: in these
perwe
physician
overelf
lhrealening
criteria
staffed
M
lhrombolysls
in March
Cardiologiche
for diagnosis
six hours fmm
hour. 56.5%
Emergenze
pa”).
AND
CASACCIA
hosplfals
in Tun”
Unit (MICU),
awle
P
on community
was starled
ou1 3523 missKms,
suspected
INFARCTION
SCACCIATELLA
experience
therapy
(Servizio
and equppea
intewentms, 20.7% of petie”ls -pfs 12.8 years (3446). Media” decision 58.7%
M
lnfeneive
MYOCARDIAL
EXPERIENCE
Hasp,tal
System
phywa”
ACUTE
(ITALY)
thrombdyOc
Emergencies
is based
m advanced
SICURD
BanMa
and safety
hterature
comprehensive
F
S.Giavarm
o” feas~bdlty
OF
THE TURlN
A., SERTELLD
D,vis~on
and from
MANAGEMENT
THRDMSDLYSIS.
DE BERNARD, Cardiology
UNlT
Emergencves,
,s feas,Me wth
(Cardiac
Arrest,
with thmmbolyas (8.8%
male,
compared treated
IS%
female),
hypofenslo”, in treated 33.9%
of pfs not treated
lifepts The
in pfs older (12% I” pts
pts IS to be stressed
and safe,
low complicabo”
20.8%
v&h
severe end 4,3%
wifh,”
e” Emerpency
and moltality
Med,ca,
System
Conclusions: CPR In AMI current practice in Germany, Nonrandomized pts receiving CPR have a better short term
is a predictrx of poor short term prognosis. In a third of CPR pts with AMI receive thrombolysis. thrombolysis despite the relative contraindication outcome
rate and “o adfuntiive
MS& acute
myocaldial
lnfarcfio”
prehospital
thmmbolysis
cardiac
emergencies
Cardiopulmonarv
resuscitation.
myocardial
infarction,
thrcxnbolysis
0120 CIRCADIAN VARIATION OF SUDDEN CARDIAC DEATH, DUE TO VtNTRICULAR FIBRILLATION: DOES IT DEPEND ON UNDERLYINQ DtSEASE? H-R.
ARNTZ.
KLINIKUM
032
P. KmInONI,
v. CICLIO. w. ROLLOldI, c. ROSCIO, 1. sP*IIp*"Am A#Il n. PISml.ESE
M. OEFF,
S. N. WILLICH,
T. BRUGGEM,MN.
R. STERN,
DPI.
CARDIowu(oLDGY.,
STEGLITZ.FREEUNIVERSITYBERLIN.HINDEN6URGDAMM30. D-12200BERLIN
The incidence o! sudden cardiac death, due to ventricular iibrlllatii (VF) is characterized by a btphasic circadian distribution wtih a major primary morning and an secondary early evening peak. There is a lack of information on the potenttal influence of underlying disease on this circadian variation. We therefore analyzed 441 consecutive prehospital resuscitation attempts in patients wlh VF, performed by the Berlin Fire Brigade in during the years 1889-1991 in the Klinikum Steglitz area (population about 35O.ooO). VF was documented &her in automated external defibriltators in emergency medical technician-initiated resusoi!ati~s (n&94) or by means of manual defifxillators in patients in whom resuscitation was begun by emergency physicians (n=147; hospital based emergency physicians form the second tier of the two-tiered Berlin EMS-system). Twohundred and sforty (54%) of the patients were successfully resusottated in the field and admltted to hospital alive. In 91 patients an acute myocardiil infarction could be defined as underlying disease (age 64i13 years, 68% male). 99 patients had primary VF (age 7ofll years, 62% male). In the remaining patients the triggering underlying disease could not be established because of early death after hospital admission (n=45). In another five patients VF was tnggered by unusual conditions like severe hypokaliemia or bleeding. The typical circadian variation (ps.001) could bs demonstrated in all VF-patients. and in those beeing admitted to hospital alive as well as in both subgroups with VF caused by acute myocwdiil infarction or primary VF. Younger patients with primary VF had a tendency to a more pronounced afternoon peak compared to younger AMI -patients who showed a more pronounced morning peak of events. Conclusion: The characteristic circadian variation of sudden card& death due to VF remains generally uninfluenced by underlying disease. Circadian variation, ventricular fibrillation, myocardial infarction, sudden death