THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION IN THE EMERGENCYDEPARTMENT

Introduction and objectives. Although the importance of the early use of thrombolytic therapy in acute myocardial infarction has been demons trated, it is usual to detect an unacceptable delay in its administrat ion. We measured the in-hospital delay and, when it was determined we designed a protocol to reduce it. Method. From January-92 to December- 94 we performed a prospective analysis of the measured delay for patie nts with a diagnosis on admission of acute myocardial infarction or un stable angina within 24 hours of the onset of symptoms. To ensure a ho mogenous population, we established a triage system: priority I, delay of the therapy not admissible and so immediate administration of thro mbolytic agent (performed in the emergency department); priority II, n eed for a careful evaluation of the risk/benefit ratio for thrombolyti c therapy and administration, when indicated, after admission to the c oronary care unit, and priority III, thrombolytic therapy whether indi cated or contraindicated. All data were evaluated periodically in orde r to detect possible failures and to corret them. Results. A total of 1,462 patients with a diagnosis of acute myocardial infarction (n = 1, 006) or unstable angina (n = 456) were included. The administration of lytic therapy in the emergency department reduced the In-Hospital del ay for thrombolisis by 54% from a median of 65 minutes (45 and 110) to 30 minutes (15, and 60) (p < 0.001) in priority I patients (40% of th e patients diagnosed with AMI). For all eases with thrombolytic therap y this time was reduced from 87.5 minutes (50 and 155) to 50 minutes ( 25 and 110) minutes (p < 0.001). Conclusions. Awareness of our in-hosp ital delay, establishing a triage system in the emergency department a nd administering thrombolytic drugs in the this area has made it possi ble to provide this therapy to selected patients as early as possible.