Cochrane corner: prehospital versus in-hospital thrombolysis for ST-elevation myocardial infarction

The WHO reports that cardiovascular disease is the leading cause of death worldwide, with> 80% of these deaths occurring in lowerincome and middle-income countries (LMICs). 1 ST-elevation myocardial infarction (STEMI) can be treated either with percutaneous coronary interventions (PCIs) or thrombolytic agents, which are most effective if given in the first few minutes to hours after onset of symptoms. While traditionally thrombolysis is given in-hospital, prehospital thrombolysis is proposed as an effective intervention to save time and reduce mortality and morbidity in individuals with STEMI. Despite some evidence that prehospital thrombolysis may be delivered safely, there is a paucity of data from controlled trials to indicate whether the timing of delivery can be effective in reducing key clinical outcomes specifically in STEMI in LMICs. In this Cochrane Corner, we highlight a Cochrane review 2 that assessed the...