Medknow Publications on behalf of the Indian Society of Critical Care Medicine
Abstract
Background: Fibrinolytic therapy has reduced mortality following acute
myocardial infarction (AMI) with the major effect coming from early
achievement of infarct-related artery patency. Aim: To evaluate the
door-to-needle time for fibrinolytic administration for AMI and to
identify factors associated with a prolonged door-to-needle time.
Materials and Methods: Our study was a prospective audit of patients
who were thrombolyzed for AMI at our hospital from July 1, 2004 to
March 15, 2005. All patients admitted with AMI, who were candidates for
fibrinolysis, were included. We recorded the door-to-needle time.
Whenever possible, we tried to find out the reason for prolonged
door-to-needle time. Results: A door-to-needle time of < 30 min
could be achieved in 19 of our 35 patients (54.28%). Mean
door-to-needle time was 45.25 min. Discussion: Although most
guidelines recommend a door-to-needle time of less than 30 min, most
hospitals fail to achieve this in most patients. A study conducted by
Zed et al. at the Vancouver General Hospital showed that a
door-to-needle time of less than 30 min was achieved in only 24.3%. The
door-to-needle time achieved at our center was shorter. In most of our
patients who were thrombolyzed late, a delay in taking or interpreting
an electrocardiogram was responsible. Transfer to the intensive care
unit for thrombolysis also resulted in considerable delay.
Conclusions: A door-to-needle time of less than 30 mins could be
achieved in 19 of our 35 patients (54.28%). A significant number of AMI
patients thrombolyzed did not meet the guideline for door-to-needle
time of less than 30 min