Abstract
The objective of this study was to evaluate the efficacy of t-PA in patients who developed ACS in remote islands. We reviewed retroactively the consecutive 32 ACS cases with ST elevation who were transferred from remote islands by helicopters from April 1, 2005 to March 31, 2009. In 32 patients, 24 males were included. Mean age was 64.4（±13.4) years old. 11 patients who were treated with t-PA were designated to t-PA group while the other 21 were to non-t-PA group. 64% of t-PA group had the culprit stenotic lesions in LAD, comparing with 42.8% of non-t-PA group. This meant that t-PA was tended to be administered in more severe cases. In the coronary angiography, 36% of t-PA group gained initially TIMI3 flow, but only 23% of non-t-PA group. In spite of better angiographycal results, there was no difference in elevated CK level and LVEF afterwards in both groups. The average time of 2 hours from initial admission to the local medical services to t-PA administration would be the reason for unfavorable results. In t-PA group, the adverse event rate such as hemorrhagic events or fatal arrhythmias was not different from that of non-t-PA group. t-PA is effective treatment for ACS patients in islands far away from PCI centers. It is a clinical challenge to introduce t-PA in adequate cases promptly.
