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Call-to-needle times for thrombolysis in acute myocardial infarction in Victoria

Anne-Maree Kelly1, Debra Kerr, Ian Patrick

  • 1Joseph Epstein Centre for Emergency Medicine Research, Western Hospital, Private Bag, Footscray, Victoria 3011, Australia. Anne-Maree.Kelly@wh.org.au

The Medical Journal of Australia
|April 17, 2003
PubMed

Insights

61% of ST-elevation myocardial infarction (STEMI) patients in Victoria met the 90-minute call-to-needle (CTN) benchmark. Exceeding this benchmark increased mortality risk, highlighting the need for region-specific strategies to improve STEMI treatment times.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Public Health

Background:

  • ST-elevation myocardial infarction (STEMI) requires rapid treatment to minimize cardiac damage.
  • The British Heart Foundation established a 90-minute call-to-needle (CTN) benchmark for thrombolysis in STEMI patients.
  • Assessing adherence to and validation of this benchmark in real-world settings is crucial.

Purpose of the Study:

  • To determine the proportion of STEMI patients in Victoria treated within the 90-minute CTN benchmark.
  • To validate the British Heart Foundation's 90-minute benchmark by assessing its association with in-hospital mortality.
  • To identify factors influencing CTN times in STEMI patients.

Main Methods:

  • A cohort study was conducted involving 1147 patients with STEMI in Victoria, Australia.
  • Data were collected from 20 hospitals and two ambulance services.
  • Key outcome measures included call-to-needle (CTN) time and in-hospital mortality.

Main Results:

  • The median CTN time was 83 minutes (mean 93.2 min).
  • 61% of patients received thrombolysis within the 90-minute benchmark.
  • Patients with CTN times exceeding 90 minutes had an 80% increased risk of mortality (RR 1.8, 95% CI 1.3-2.7).
  • Factors associated with achieving the benchmark included shorter door-to-needle (DTN) times, prior hospital notification, and transport times under 20 minutes.

Conclusions:

  • The British Heart Foundation's 90-minute CTN benchmark is met by 61% of eligible STEMI patients in Victoria.
  • Strategies to reduce CTN times should be tailored to specific regions, focusing on reducing DTN and improving ambulance-hospital communication.
  • Prehospital thrombolysis may be a viable option in certain regions to improve timely STEMI care.
Abstract

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