Achieving earlier thrombolysis in acute myocardial infarction

Abstract EN

Objective : Study the in-hospital delays in administering thrombolytic therapy to patients of Acute Myocardial Infarction (AMI), the reasons for such delays and if they could be avoided.

Setting : Accident and Emergency Department (A/E) and Coronary Care Unit (CClJ) of the Salmaniya Medical Centre (SMC), Bahrain.

Design : Retrospective study of sixty six consecutive patients of AMI who were treated with thrombolytic drugs over a six month period from January to June 1994.

Subjects & Methods: Sixty six patients diagnosed to have AMI in the A/E were given thrombolytic therapy either in A / E or in the CClJ.

Besides their demographic variables, the duration of symptoms before arrival, the time lag from arrival to actual administration ofthrombolytic drug and the reasons for such time lag were analysed.

Results: 80.3 % patients arrived within six hours of chest pain.

7.5 % patients were treated within an hour of arrival, 28.8 % within 1-2 hours, 25.7 % within 2-3 hours, 18.2 % within 3-4 hours and 19.7 % beyond 4 hours wi th an average hospital delay of 175 minutes.

The major reasons for the delays were: delayed referrral from A / E, transfers to CCU and awaiting laboratory reports.

Conclusions : The hospital delay which occurs in administering a thrombolytic drug to AM I patients, reduce the benefits of such therapy and is avoidable.

Steps should be talen to eliminate this delay and administer thrombolytic therapy to AMI patients at the earliest; preferably within an hour of arrival to the hospital.