1887
  1. Home
  2. A-Z Publications
  3. Qatar Medical Journal
  4. Volume 2008, Issue 1
  5. Article
Volume 2008, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

The elevation of reperfusion therapy for acute STsegment elevation myocardial infarction are time-related and there are decreasing benefits with increasing delays to therapy. To determine whether the time interval between a patient's arrival at the emergency department of Hamad General Hospital, Qatar and initiation of thrombolytic therapy in the coronary care unit (door-to-needle time) is within the 30 minutes recommended by American College of Cardiology!American Heart Association guidelines, the medical records were reviewed of 213 patients with STsegment elevation myocardial infarction who were admitted through the Emergency Department to receive thrombolysis in the Coronary Care Unit in the twelve months May 2006-April 2007. Medians were calculated for door-to-needle and painto-needle times and intermediate points. The median painto-needle and pain-to-door times were 211 and 143 minutes respectively, both increasing significantly with the age of the patient and were shorter in men than in women. The median door-to-needle time was 60 minutes with 11.7% of the sample having a door-to-needle time within the recommended 30 minutes. It is concluded that the need for transferring such patients from the emergency department to the coronary care unit of the hospital before the administration of thrombolysis incurs inevitable delays that can be minimized by administering thrombolysis in the emergency department.

© 2008 Nuaimi, Chetachi, Gehani, licensee Bloomsbury Qatar Foundation Journals.
Loading

Article metrics loading...

/content/journals/10.5339/qmj.2008.1.14
2008-06-01
2021-09-24
Loading full text...

Full text loading...

References

  1. Antman EM, Braunwald E. ST-segment elevation myocardial, the Prevalence and Characteristics of CA-MRSA in KSABello C.S.S., et al. infarction. In: Kasper DLBraunwald EFauci ASHauser SLLongo DLJameson JL, eds. Harrison's Principles of Internal Medicine. Volume II. 16th Edition. New York: McGraw Hill 2005;:1448–1459.
     [Google Scholar]
  2. Taher T, Eu Y, Wagner GS, et al., Aborted myocardial infarction in patients with ST-segment elevation. Insights from the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen-3 Trial Electrocardiographic Sub study. JACC. 2004; 44:1:38–43.
     [Google Scholar]
  3. Fibrinolytic Therapy Trialists’ (FTT). Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1000 patients. Lancet. 1994; 343::311–322.
     [Google Scholar]
  4. Antman EM, Anbe DT, Armstrong PW, et al., ACC/AHA guidelines for the management of patients with ST elevation myocardial infarction-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). Circulation. 2004; 110::588.
     [Google Scholar]
  5. Waters R, Mahaffey K, Granger C, et al., Current perspectives on reperfusion therapy for acute ST segment elevation myocardial infarction: integrating pharmacologic and mechanical reperfusion strategies. Am Heart J. 2003; 146::958–968.
     [Google Scholar]
  6. Rogers WJ, Canto JG, Lambrew CT, et al., Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction I, 2 and 3. J Am Coll Cardiol. 2000; 36::2056–2063.
     [Google Scholar]
  7. GISSI Investigators. Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet. 1986; i::397–402.
     [Google Scholar]
  8. ISIS-2 Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction: ISIS-2. Lancet. 1988; ii::349–360.
     [Google Scholar]
  9. GUSTO investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med. 1993; 329::673–682.
     [Google Scholar]
  10. Fibrinolytic Therapy Trialists'. (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials or more than 1000 patients. Lancet. 1994; 343::311–322.
     [Google Scholar]
  11. Luepker RV, Raczynski JM, Osganian S, et al., Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease. The Rapid Early Action for Coronary Treatment (REACT). Trial JAMA. 2000; 284::60–67.
     [Google Scholar]
  12. Leizorovicz A, Haugh MC, Mercier C, et al., Pre-hospital and hospital time delays in thrombolytic treatment in patients with suspected acute myocardial infarction: analysis of data from the EMIP study. European myocardial infarction project. European Heart Journal. 1997; 18::248–253.
     [Google Scholar]
  13. Banks AD, Dracup K. Factors associated with prolonged prehospital delay of African Americans with acute myocardial infarction. Am J Crit Care. 2006; 15:2:149–157.
     [Google Scholar]
  14. Goldberg RJ, Gurwitz JH, Gore JM. Duration of, and temporal trends (1994-1997) in, prehospital delay in patients with acute myocardial infarction. Arch Intern Med. 1999; 159::2141–2147.
     [Google Scholar]
  15. Di Chiara A, Chiarella F, Savonitto S, et al., Epidemiology of acute myocardial infarction in the Italian CCU network: The BLITZ study. European Heart Journal. 2003 Sep; 24:18:1616–1629.
     [Google Scholar]
  16. Schmidt SB, Borsch MA. The prehospital phase of acute myocardial infarction in the era of thrombolysis. Am J Cardiol. 1990; 65::1411–1415.
     [Google Scholar]
  17. Yarzebski J, Goldberg RJ, Gore JM, et al., Temporal trends and factors associated with extent of delay to hospital arrival in patients with acute myocardial infarction: The Worcester Heart Attack Study. Am Heart J. 1994; 128::255–263.
     [Google Scholar]
  18. Maynard C, Althouse R, Olsufka M, Ritchie JL, Davies KB, Kennedy JW. Early versus late hospital arrival for acute myocardial infarction in the Western Washington Thrombolytic Therapy Trials. Am J Cardiol. 1989; 63::1296–1300.
     [Google Scholar]
  19. Kostis JB, Wilson AC, Lacy CR, et al., Time trends in the occurrence and outcome of acute myocardial infarction and coronary heart disease death between 1986 and 1996 (a new statewide study). Am J Cardiol. 2001; 88::837–841.
     [Google Scholar]
  20. Gonzalez ER, Jones LA, Ornato JP, et al., Hospital delays and problems with thrombolytic administration in patients receiving thrombolytic therapy: a multicenter prospective assessment. Virginia Thrombolytic Study Group. Ann Emerg Med. 1992; 21::1215–1221.
     [Google Scholar]
  21. Lambrew CT, Bowlby LJ, Rogers WJ, et al., Factors influencing the time to thrombolysis in acute myocardial infarction. Arch Intern Med. 1997; 157::2577–2582.
     [Google Scholar]
  22. Corfield AR, Graham CA, Adams JN, et al., Emergency Department thrombolysis improves door-to-needle times. Emerg Med J. 2004; 21::676–680.
     [Google Scholar]
  23. Hourigan CT, Mountain D, Langton PE, et al., Changing the site of delivery of thrombolytic treatment for ST elevation myocardial infarction from the coronary care unit to the Emergency Department greatly reduces door-to-needle time. Heart. 2000; 84::157–156.
     [Google Scholar]
  24. Prasad N, Wright A, Hogg KJ, et al., Direct admission to the coronary care unit by the ambulance service for patients with suspected myocardial infarction. Heart. 1997; 78::462–464.
     [Google Scholar]
  25. Thomas D, Cooper L, Cooper J, et al., Direct fast track admission to a coronary care unit. J R Coll Physicians Lond. 1997; 31::188–191.
     [Google Scholar]
  26. Wilms hurst P, Purchase A, Webb C, et al., Improving door-toneedle times with nurse initiated thrombolysis. Heart. 2000; 84::262–266.
     [Google Scholar]
  27. Qasim A, Malpass K, O'Gorman DJ, Heber ME. Safety and efficacy of nurse initiated thrombolysis in patients with ST elevation myocardial infarction. BMJ. 2002; 324::1328–1331.
     [Google Scholar]
  28. Mac Callum AG, Stafford PJ, Jones C, Vincent R, Perez-Avila C, Chamberlain DA. Reduction in hospital time to thrombolytic therapy by audit of policy guidelines. European Heart Journal. 1990; 11:Suppl. F:48–52.
     [Google Scholar]
  29. Bryant M, Kelly AM. “Point of entry “ treatment gives best time to thrombolysis for ST elevation myocardial infarction. Australian Health Review. 2001; 24::157–160.
     [Google Scholar]
  30. Edhouse JA, Sakr M, Wardrope J, et al., Thrombolysis in ST elevation myocardial infarction: the safety and efficiency of treatment in the accident and emergency department. J Accid Emerg Med. 1999; 16::325–330.
     [Google Scholar]
  31. Chan WK, Lam KN, Lau FL, et al., Starting thrombolytic therapy for patients with ST elevation myocardial infarction in accident and Emergency department: from implementation to evaluation. Chin Med J. 1998; 111::291–294.
     [Google Scholar]
  32. Boersma E, Maas AC, Deckers JW, et al., Early thrombolytic treatment in ST elevation myocardial infarction: Reappraisal of the golden hour. Lancet. 1996; 348::771–775.
     [Google Scholar]
  33. Boisjolie CR, Sharkey SW, Cannon CP, et al., Impact of a thrombolysis research trial on time to treatment for ST elevation myocardial infarction in the emergency department. Am J Cardiol. 1995; 76::396–398.
     [Google Scholar]
  34. Newby LK, Rutsch WR, Califf RM, et al., Time from symptom onset to treatment and outcomes after thrombolytic therapy. GUSTO-1 Investigators. J Am Coll Cardiol. 1996; 27::1646–1655.
     [Google Scholar]
  35. Selker HP, Griffith JL, Beshansky JR, et al., Patient-specific predictions of outcomes in myocardial infarction for real-time emergency use: a thrombolytic predictive instrument. Ann Intern Med. 1997; 127::538–556.
     [Google Scholar]
  36. Topol EJ, Ohman EM, Armstrong PW, et al., Survival outcomes 1 year after reperfusion therapy with either alteplase or reteplase for ST elevation myocardial infarction: results from the global utilization of streptokinase and t-PAfor occluded coronary arteries (GUSTO) III Trial. Circulation. 2000; 102::1761–1765.
     [Google Scholar]
  37. Boersma E. The Primary Coronary Angioplasty vs. Thrombolysis (PCAT)-2 Trialists’ Collaborative Group. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients. European Heart Journal. 2006; 27::779–788.
     [Google Scholar]
  38. Gersh BJ, Antman EM. Selection of the optimal reperfusion strategy for STEMI: does time matter? European Heart Journal. 2006; 27::761–763.
     [Google Scholar]
  39. Thorn S, Attali P, Boulenc JM, et al., Delays of treatment of acute myocardial infarction with ST elevation admitted to the CCU (coronary care unit) in Alsace. Arch Mai Coeur Vaiss. 2007; 100:1:7–12.
     [Google Scholar]
  40. Newby LK, Rutsch WR, Califf RM, et al., Time from symptom onset to treatment and outcomes after thrombolytic therapy. J Am Coll Cardiol. 1996; 27::1646–1655.
     [Google Scholar]
  41. Berglin BM, Hartford M, Karlsson T, et al., Factors associated with pre-hospital and in-hospital delay time in acute myocardial infarction: a 6-year experience. J Intern Med. 1998; 243::243–250.
     [Google Scholar]
  42. Berton G, Cordiano R, Palmieri R, et al., Clinical features associated with prehospital time delay in acute myocardial infarction. Ital Heart J. 2001; 2::766–771.
     [Google Scholar]
  43. Gibson CM, Murphy SA, Kirtane AJ, et al., TIM1 Study Group. Association of duration of symptoms at presentation with angiographic and clinical outcomes after fibrinolytic therapy in patients with st-segment elevation myocardial infarction. J Am Coll Cardiol. 2004; 44::980–987.
     [Google Scholar]
  44. Weaver WD. Time to thrombolytic therapy: factors affecting delay and their influence on outcome. J Am Coll Cardiol. 1995; 25:suppl:3S–9S.
     [Google Scholar]
  45. Morrow DA, Antman EA, Sayah A, et al., Evaluation of the time saved by prehospital initiation of reteplase for ST-elevation myocardial infarction. J Am Coll Cardiol. 2002; 40::71–77.
     [Google Scholar]
  46. Morrison LJ, Verbeek PR, McDonald AC, et al., Mortality and pre-hospital thrombolysis for acute myocardial infarction: A meta-analysis. JAMA. 2000; 283::2686–2692.
     [Google Scholar]
  47. Huber K, Caterina RDe, Kristensen SD, et al., Pre-hospital reperfusion therapy: a strategy to improve therapeutic outcome in patients with ST-elevation myocardial infarction. European Heart Journal. 2005; 26::2063–2074.
     [Google Scholar]
  48. Weaver WD, Cerqueira M, Hallstrom AP, et al., Pre hospitalinitiated vs hospital-initiated thrombolytic therapy. The myocardial infarction triage and intervention trial. JAMA. 1993; 270::1211–1216.
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2008.1.14
Loading
  • Article Type: Research Article
Keyword(s): door-to-needle time , ST-segment elevation myocardial infarction and thrombolytic therapy
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error