[Time delay in the thrombolytic treatment of myocardial infarction]

Thrombolytic treatment is central in the treatment of patients with myocardial infarction.

A cross-sectional study was conducted to determine the time delay incurred in thrombolytic treatment of patients with myocardial infarction in Ostfold Hospital, Fredrikstad, Norway. Over a seven-month period, 317 patients were diagnosed as having myocardial infarction. 80 patients (25%) received thrombolytic therapy, 68 of whom (85%) were eligible for the study. 12 patients were excluded either because of not meeting the inclusion criteria or because of incomplete data.

The following median times were recorded: from onset of chest pain till first contact with the health care services, 59 minutes; from first contact till arrival at hospital, 32 minutes; from hospital arrival till initiation of treatment, 40 minutes; from onset of chest pain till initiation of treatment, 147 minutes. 38% of the patients received thrombolysis within 120 minutes of pain onset, and 35% received treatment within 30 minutes of arrival in hospital. There was no difference in time delay before contacting health care services among patients with or without a previous history of coronary heart disease, except for those who took nitroglycerine at onset of symptoms. They had the longest time delay.

In order to reduce time delay, doctors should give better instructions to patients with a previous history of coronary heart disease and conduct regular training programmes for hospital interns and nurses. It is further assumed that prehospital ECG and direct admission to the coronary care unit, or initiation of thrombolysis in the emergency department or in the ambulance, would result in a considerable reduction in time delay.