Thrombolysis in acute myocardial infarction: the safety and efficiency of treatment in the accident and emergency department

Objectives-To assess the safety and efficiency with which the accident and emergency (A&E) department provides thrombolytic treatment for patients wit h acute myocardial infarction (AMI). Methods-A prospective observational study based in a teaching hospital for one year. All patients who presented with the clinical and electrocardiogra phic indications for thrombolytic treatment were studied. Patients were gro uped according to route of admission. After logarithmic transformation, the "door to needle times" of the groups were compared using a two tailed Stud ent's t test. Arrhythmias and complications after thrombolytic treatment we re noted. The appropriateness of the treatment was assessed retrospectively by review of the clinical records and electrocardiograms, judged against l ocally agreed eligibility criteria. Results-Data from 153 patients were analysed; 138/153 (90%) patients were a dmitted via the A&E department. The shortest door to needle times were seen in those patients thrombolysed by A&E staff within the A&E department (mea n 43.8 minutes). The transfer of A&E patients to the coronary care unit (CC U) was associated with a significant increase in the door to needle time (m ean 58.8 minutes, p = 0.004). Only one malignant arrhythmia occurred during the administration of thrombolysis in the A&E department, and this was man aged effectively. No arrhythmias occurred during transfer of thrombolysed p atients to the CCU. In every case, the decision to administer thrombolysis was retrospectively judged to have been appropriate. Conclusions-The A&E department provides appropriate, safe, and timely throm bolytic treatment for patients with AMI. Transferring A&E patients to the C CU before thrombolysis is associated with an unnecessary treatment delay.