Out-of-Hospital Treatment and 1-Year Survival in Patients With ST-Elevation Acute Myocardial Infarction. Results of the Spanish Out-of-Hospital Fibrinolysis Evaluation Project (PEFEX)

Background and objectives. To investigate out-ofhospital treatment, including fibrinolysis, in patients with ST-elevation acute myocardial infarction and to determine the 1-year survival rate. Methods. Prospective cohort study based on an ongoing out-of-hospital registry of patients with STelevation acute myocardial infarction who were treated by out-of-hospital emergency teams in Andalusia, Spain during 2001‐2004. Patients were followed up in hospital and one year after the acute episode. Results. The study involved 2372 patients. Out-ofhospital fibrinolysis was used in 467 (19.7%). Among these, 20.7% received treatment within the first hour, 68% within the first 2 hours, and 2 (0.4%) hemorrhagic strokes occurred. Episodes of ventricular fibrillation were recorded in 158 patients (6.7%), 106 (67%) of whom were discharged. In addition, 386 (16.3%) patients died in the short term (both out of and in hospital), with 26 (1.1%) dying before they reached hospital. The cumulative 1year mortality rate was 22.4% (531 patients) overall, and 6.6% (29 patients) in the out-of-hospital fibrinolysis group. Increased survival at 1 year was associated with out-ofhospital fibrinolysis (odds ratio [OR]=0.368; 95% confidence interval [CI], 0.238‐0.566) and percutaneous coronary intervention during admission (OR=0.445; 95% CI, 0.268‐0.740). Conclusions. In routine clinical practice, out-of-hospital fibrinolysis was performed safely, reduced short-term mortality, and improved the 1-year survival rate. The combination of appropriate out-of-hospital treatment,