DANGERS OF DELAY OF INITIATION OF EITHER THROMBOLYSIS OR PRIMARY ANGIOPLASTY IN ACUTE MYOCARDIAL-INFARCTION WITH INCREASING USE OF PRIMARY ANGIOPLASTY

We observed treatment delays and suboptimal outcomes when beginning to treat patients with acute myocardial infarction (AMI) with primary an gioplasty. Of the 37 patients treated during a 12-month period, 12 (32 %) required either emergency bypass surgery or died. Delayed time inte rvals to balloon reperfusion (mean 134 minutes) probably contributed t o these adverse outcomes, with hemodynamic instability requiring press ors or intra-aortic balloon pumping in 15 patients, 12 (75%) before th e first balloon inflation. Eleven of the 12 patients with significant adverse outcomes required such intervention. As angioplasty use increa sed, time intervals to thrombolysis in those not treated with angiopla sty increased from an average of 29 minutes (53% treated less than the notional standard of 30 minutes) to 39 minutes (32% treated < 30 minu tes, p < 0.001). During the last 2 months of the study period, the tim e intervals had increased to 48 minutes (14% treated < 30 minutes, p < 0.0001). There was no change in thrombolytic time intervals at a loca l community hospital that did not offer primary angioplasty. Emergency Department physician confusion about the best therapy (angioplasty or thrombolysis) was documented in the medical records in 42% of cases ( 53 of 127). Confusion regarding therapy of AMI led to unacceptable del ays in the administration of thrombolytic agents and probably contribu ted to the adverse outcomes in patients receiving primary angioplasty. (C) 1998 by Excerpta Medica, Inc.