STARTING THROMBOLYTIC THERAPY FOR PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION IN ACCIDENT AND EMERGENCY DEPARTMENT - FROM IMPLEMENTATION TO EVALUATION

Objective To evaluate the effectiveness of initiating thrombolysis for patients with acute myocardial infarction (AMI) in the Accident and E mergency Department. Methods From January 1993 to December 1995, all A MI patients who were admitted to the United Christian Hospital and giv en thrombolytic therapy were studied. The patients' demographic data, time and mode of presentation, site of myocardial infarction, treatmen t modality and timing, and complications related to AMI or treatment w ere recorded prospectively in our AMI database. The frequency of throm bolysis administered in Accident and Emergency Department and Coronary Care Unit, as well as the median door-to-needle time (time interval b etween hospital arrival to initiation of thrombolytic therapy) were co mpared. Cases of inappropriate thrombolysis and complication were also analyzed. Results Over these 3 years, 257 patients received thromboly sis in the United Christian Hospital. The percentage of patients recei ving thrombolysis in Accident and Emergency Department increased from 3.2% in 1993 to 12.3% in 1994, and to 39.4% in 1995. The median time i nterval between arrival to hospital and thrombolysis (door-to-needle t ime) was 25 minutes, compared with 81 minutes in the Coronary Care Uni t. The door-to-needle time also improved over these 3 years: from 95 m inutes in 1993 to 75 minutes in 1995 in Coronary Care Unit group, and from 35 minutes in 1993 to 20 minutes in 1995 in the Accident and Emer gency Department group. Over these 3 years, 2 cases of inappropriate t hrombolysis were reported but these did not result in any mortality. F our complications from thrombolytic therapy were reported, and these w ere managed appropriately by the staff in Accident and Emergency Depar tment and did not result in mortality. Conclusions Starting thrombolyt ic therapy in Accident and Emergency Department is safe and effectivel y decreases the door-to-needle time.