IMPACT OF A THROMBOLYSIS RESEARCH TRIAL ON TIME TO TREATMENT FOR ACUTE MYOCARDIAL-INFARCTION IN THE EMERGENCY DEPARTMENT

Time from onset of symptoms of acute myocardial infarction (AMI) to tr eatment with thrombolytic therapy is a critical determinant in infarct size and mortality.(1-7) After initial reports of the importance of t ime to treatment in AMI, many hospitals introduced protocols to reduce the time from arrival in the emergency department (ED) to the start o f thrombolytic therapy, termed the ''door-to-needle'' time.(8-11) Init ially these protocols, along with increased general awareness, resulte d in a reduction of time to treatment.(11-13) However, despite conside rable attention and effort, further reductions have been difficult to accomplish.(14) In an effort to improve the rate and stability of repe rfusion, multiple new thrombolytic and antithrombotic regimens are bei ng studied. The Thrombolysis in Myocardial Infarction (TIMI) 5 trial w as a randomized trial of hirudin, a new specific thrombin inhibitor ve rsus heparin in conjunction with tissue plasminogen activator for pati ents with AMI.(15) It was a complex, labor-intensive trial with extens ive inclusion/exclusion criteria, a 5-page consent form, telephone ran domization, a bolus of hirudin or heparin before initiation of thrombo lytic therapy, and early angiography. There was considerable concern t hat this process would add significant delays to time to treatment. We therefore examined the effect of the TIMI 5 trial on time to treatmen t of patients with AMI admitted to the ED in the 2 hospitals enrolling patients in Minneapolis, Minnesota.