A recent story from the Canadian Press talks about the international STREAM study (Strategic Reperfusion Early After Myocardial Infarction).
“It’s widely recognized that the faster you treat a heart attack, the better the outcomes,” says Dr. Warren Cantor, a cardiologist at Southlake. “You can preserve heart muscle and increase a patient’s chance of survival by opening the artery quicker.”
“Furthermore, we now realize you can save approximately one hour if you diagnose the heart attack in the ambulance as opposed to in an emergency department.”
I certainly can’t disagree with that.
So far, more than 400 patients worldwide have been included in the STREAM protocol, which compares two treatment strategies.
The first involves giving a clot-busting medication in the ambulance, followed by artery-opening balloon angioplasty within 24 hours, while the second has a patient undergoing angioplasty within three hours, without a prior clot-dissolving drug.
This study will not resolve the question as to whether or not primary PCI with prolonged transfer times is superior to fibrinolytic therapy followed immediately by PCI.
Now the really interesting quote.
“So what we’re looking at is whether patients may benefit by getting the clot-busting medication in the ambulance,” explains Cantor. “And in order to do that, you can’t rely on a paramedic interpreting the ECG. A physician really has to confirm the heart attack.”
The obvious question is, why can’t you rely on a paramedic interpreting the ECG?