Time delay in the treatment of acute myocardial infarction (AMI): a comparison of primary percutaneous transluminal coronary angioplasty (PTCA) with thrombolysis.
BACKGROUND
If primary percutaneous transluminal coronary angioplasty (PTCA) cannot be performed within times comparable to thrombolysis, the possible advantages of that management may be offset by the logistic difficulties associated with its delivery.


OBJECTIVE
To measure and compare the time delay involved in administration of thrombolysis and primary PTCA over a one year period and examine causes for delay greater than 60 minutes.


METHODS
Prospective data collection on all patients treated with primary PTCA or thrombolysis. A quality improvement process was applied.


RESULTS
Eighty-five patients were treated with thrombolysis with a delay of 39 +/- 8 (SD) minutes, 12 patients being treated more than 60 minutes after presentation. Primary PTCA was used in 79 patients with a delay of 48 +/- 12 (SD) minutes, 21 patients being treated after more than 60 minutes. Time delays in the two management groups were significantly different (p = 0.03) but that in primary PTCA during routine hours was not significantly different from that in thrombolysis treated patients (p = 0.07). Causes for revascularisation delay greater than 60 minutes from presentation are discussed.


CONCLUSIONS
With appropriate facilities and organisation, patients with acute myocardial infarction presenting within normal working hours can be treated with primary PTCA without compromising their care due to time delay. Many patients managed with primary revascularisation by thrombolysis or primary PTCA with a delay of more than 60 minutes have identifiable clinically appropriate delays.
Hitchcock
T
T
Department of Emergency Medicine, Royal Perth Hospital, WA.
Kidd
H M
HM
Taylor
R
R
D015906:Angioplasty, Balloon, Coronary; D001071:Appointments and Schedules; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011446:Prospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors