IMPROVING THE MANAGEMENT OF ACUTE MYOCARDIAL, INFARCTION WITH THE IMPLEMENTATION OF A THROMBOLYSIS UNIT IN THE CARDIOLOGY DEPARTMENT

Introduction and objectives. Lack of available beds in the coronary ca re unit, makes time to thrombolysis still too long. Although fibrinoly tic therapy is administered in the emergency department in most hospit als, mean in-hospital delay continues to be long. Our purpose was to i mprove the treatment of these patients and to evaluate if this delay c ould be shortened by creating a thrombolysis unit for the treatment of patients with acute myocardial infarction. Methods. A thrombolysis un it in the cardiology department was set up to treat patients with acut e myocardial infarction who couldn't be admitted directly in the coron ary care unit because of lack of available beds. Time to treatment in both groups of patients mere compared. Results. Two hundred twenty-fiv e patients with acute myocardial infarction and ST-segment elevation w ere included: 86 (38%) of them were admitted to the thrombolysis unit and the other 139 (62%) to the coronary care unit. There were no diffe rences in baseline characteristics or in the prehospital delay between both groups. Time from hospital admission to thrombolysis was 59 minu tes in patients treated in the thrombolysis unit versus 70 minutes in those treated in the coronary care unit (p < 0.001), and time from the admission to both units to fibrinolytic therapy was of 20 minutes ver sus 30 minutes respectively (p < 0.0001). There were no differences be tween both groups in the incidence of complications. Conclusions. In-h ospital delay in thrombolysis remains too long. Implementation of a th rombolysis unit in the cardiology department shortens this delay and o ffers the possibility to treat patients with acute myocardial infarcti on at least as well as in the: coronary care unit, without dependence on the availability of free beds in this unit.