A Study of Pre-hospital Treatment of Acute Myocardial Infarction Based on Diagnosis by Interpretation of Remotely Acquired ECG and Thrombolysis With Accelerated Alteplase ( Actilyse®)

Inclusion Criteria: * Ischemic cardiac pain of \>= 20 minutes and \<= 6 hours * Age 18 - 80 years * Ability to give informed consent (witnessed verbal or written) * Ability to follow protocol and comply with follow -up requirements Exclusion Criteria: * Current participation in another clinical trial * Patient will be ineligible for pre hospital administration of actilyse if any of the following apply: * Acute myocardial infarction (AMI) treated with a thrombolytic agent within the preceding 4 days * BP (blood pressure) \> 180/100 mmHg (on one measurement) * Significant bleeding disorder within the past 6 months * Major surgery, biopsy of a parenchymal organ, or significant trauma (including any trauma associated with the current AMI) within 3 months * History of stroke, transient ischaemic attack, or central nervous system structural damage (e.g. neoplasm, aneurysm, intracranial surgery) * Oral anticoagulation * Recent (within 10 days) non - compressible vascular puncture * Pregnancy (positive urine pregnancy test) or lactation, parturition within the previous 30 days, or female of childbearing potential not using adequate birth control (oral contraception) * Severe liver disease, including hepatic failure, cirrhosis portal hypertension (oesophageal varices) and active hepatitis * Diabetes with definite history of retinopathy * Other serious illness (e.g. malignancy, active infection) * Bacterial endocarditis / pericarditis * Acute pancreatitis * Documented ulcerative gastrointestinal disease during last 3 month, arterial aneurysms, arterial / venous malformations * Any other condition that the investigator feels would pose a significant hazard to the subject if the investigational therapy was to be initiated * Patients who are not excluded from thrombolytic therapy by the criteria above will, in addition, need to satisfy the following 'inclusion' criteria prior to the pre - hospital thrombolysis: * 12 lead ECG criteria: ST segment elevation \>= 0.1 mV in two contiguous electrocardiogram (ECG) standard leads indicative of AMI, or ST elevation \>= 0.2 mV in two contiguous chest leads and all left bundle branch block (LBBB) with clinical indication of AMI