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BARRIERS TO REDUCING TIME TO THROMBOLYSIS IN ACUTE MI.

Myocardial salvage in acute myocardial infarction (MI) is strongly influenced by the time between onset of symptoms and initiation of thrombolysis. This analysis of 1,755 MI patients focused on delays in thrombolysis initiation related to hospital triage and treatment policies. The study was sponsored by Genentech and included only patients treated with recombinant tissue-type plasminogen activator (TPA).

Of the patients, 72 percent were men, and most came to the hospital by automobile. Women arrived at the hospital longer after onset of symptoms than men (1.89 vs. 1.4 hours), and experienced a longer time from hospital presentation to infusion of TPA (71 vs. 63 minutes). The initial EKG demonstrated ST-segment elevation in 86 percent of patients overall, of whom 77 percent then received a cardiology consultation (which delayed TPA initiation by an average of 21 minutes). The primary care physicians of about half the patients were contacted before thrombolysis (which added a further median delay of 20 minutes). Mixing the TPA in the pharmacy rather than the emergency department increased time to TPA initiation by 23 minutes.

Comment: The first message of this study is to invest the emergency department with as much authority as possible for evaluation, decision-making, and TPA preparation. A second message is that women experience delays to TPA administration not fully explained by their symptoms or EKG.

— TL Schwenk

Published in Journal Watch General Medicine January 13, 1998

Citation(s):

Lambrew CT et al. Factors influencing the time to thrombolysis in acute myocardial infarction. Arch Intern Med 1997 Dec 8 157 2577-2582.

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