[Fibrinolytic treatment in acute myocardial infarction: analysis of delay].
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.
Iglesias
M L
ML
Servicios de Urgencias, Universidad Autónoma de Barcelona.
Pedro-Botet
J
J
Hernández
E
E
Solsona
J F
JF
Molina
L
L
Alvarez
A
A
Auguet
T
T
D000368:Aged; D003325:Coronary Care Units; D004636:Emergency Service, Hospital; D006801:Humans; D007262:Infusions, Intravenous; D009203:Myocardial Infarction / Q000188:drug therapy*; D013300:Streptokinase / Q000008:administration & dosage; D015912:Thrombolytic Therapy; D013997:Time Factors
D013300:Streptokinase
Tratamiento fibrinolítico en el infarto agudo de miocardio: análisis de los tiempos de demora.