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[Fibrinolytic treatment in acute myocardial infarction: analysis of delay]
M L Iglesias1, J Pedro-Botet, E Hernández
1Servicios de Urgencias, Universidad Autónoma de Barcelona.
Insights
Delays in initiating fibrinolytic treatment for acute myocardial infarction (AMI) are significant, particularly intrahospital delays. Decision-making processes contribute most to the time lag, impacting patient outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Research
Background:
- Acute myocardial infarction (AMI) requires timely intervention.
- Intravenous fibrinolytic therapy is a critical treatment for AMI.
- Understanding treatment delays is crucial for improving patient care.
Purpose of the Study:
- To analyze the delay times in initiating intravenous fibrinolytic treatment for AMI patients.
- To identify specific components contributing to total treatment delay.
- To evaluate factors influencing intrahospital delay in fibrinolysis administration.
Main Methods:
- A retrospective study of consecutive AMI patients treated at Hospital del Mar, Barcelona.
- Inclusion criteria: transmural AMI, age < 80 years, symptom onset < 6 hours.
- Analysis of total, extrahospitalary, and intrahospitalary delay times, including assistance, indication, and performance delays.
Main Results:
- Of 80 AMI patients, 33 received fibrinolytic treatment.
- Total delay time averaged 287.2 minutes.
- Intrahospitalary delay was 126.8 minutes, largely due to a 78.8-minute delay in treatment indication.
Conclusions:
- Decision delays significantly contribute to intrahospitalary delays in fibrinolytic treatment administration for AMI.
- Optimizing the decision-making process is key to reducing treatment times.
- Further research into streamlining treatment protocols is warranted.
Background:
The delay time from the onset of symptoms to the initiation of intravenous fibrinolytic treatment in patients with acute myocardial infarction (AMI) is herein described.
Methods:
A study was carried out of the consecutive AMI diagnosed in the Medical Area of the Emergency Department of the Hospital del Mar in Barcelona, Spain, with a 24-hour follow up from 15 May 1993 to 14 January, 1994. All the patients under the age of 80 years with transmural AMI of any localization and evolution of under 6 hours were considered to receive fibrinolytic treatment. The following delay times were analyzed: total delay time, extrahospitalary delay time and intrahospitalary delay time, which included assistance delay time, delay in fibrinolytic treatment indication and delay time in performance of the same.
Results:
During the study period 18,316 patients were attended in the Emergency Medical Area, of which 80 corresponded to AMI. Fibrinolytic treatment was initiated with intravenous streptokinase in 33 patients (41.3%). The total delay time was 287.2 +/- 202.6 (mean +/- SD) minutes; the extrahospitalary and intrahospitalary delays were 159.8 +/- 151.7 and 126.8 +/- 161.7 minutes, respectively. The delay time for assistance was 8.5 +/- 12.7 minutes, the delay time in treatment indication was 78.8 +/- 101.8 minutes and in performance it was 39.5 +/- 52.6 minutes. This latter time was analyzed on the basis of the administration site, with statistically significant differences (p < 0.005) if the fibrinolytic treatment was performed in the Emergency Medical Area (12.5 +/- 0.7 minutes), in the observation room (41.4 +/- 50.7 minutes) or in the Intensive Care Unit (61.4 +/- 75.8 minutes).
Conclusions:
Most of the intrahospitalary delay in the administration of fibrinolytic treatment is due to decision delay in regards to carrying out this therapy.