Call-to-needle times for thrombolysis in acute myocardial infarction in Victoria.
OBJECTIVE
To determine the proportion of patients in Victoria treated within the British Heart Foundation 90-minute call-to-needle (CTN) time benchmark for thrombolysis of ST-elevation myocardial infarction (STEMI), and to validate the British Heart Foundation 90-minute benchmark with respect to mortality.


METHODS
Cohort study.


METHODS
20 hospitals and two ambulance services in the State of Victoria, Australia.


METHODS
1147 patients with STEMI transported to hospital by ambulance and eligible for thrombolysis.


METHODS
CTN time, and in-hospital mortality.


RESULTS
Median CTN time was 83 minutes (mean, 93.2 min; range, 29-894 min). Median door-to-needle (DTN) time was 37 minutes (mean, 46.5 min; range, 0-853 min). 61% of patients received thrombolysis within the 90-minute benchmark. Patients with CTN times > 90 minutes had an increased risk of dying (relative risk, 1.8; 95% CI, 1.3-2.7). Factors associated with CTN time < 90 minutes were lower DTN time, prior notification of the receiving hospital and transport time less than 20 minutes.


CONCLUSIONS
The British Heart Foundation CTN time benchmark is being met for 61% of eligible STEMI patients in Victoria. Strategies to reduce CTN time should be region-specific, and should include attempts to reduce DTN and to enhance ambulance-hospital communication. Prehospital thrombolysis may be appropriate for some regions.
Kelly
Anne-Maree
AM
Joseph Epstein Centre for Emergency Medicine Research, Western Hospital, Private Bag, Footscray, Victoria 3011, Australia. Anne-Maree.Kelly@wh.org.au
Kerr
Debra
D
Patrick
Ian
I
Walker
Tony
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking / Q000592:standards; D015331:Cohort Studies; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000379:methods / Q000592:standards; D005260:Female; D005343:Fibrinolytic Agents / Q000592:standards / Q000627:therapeutic use*; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D017410:Practice Guidelines as Topic / Q000592:standards; D015912:Thrombolytic Therapy / Q000379:methods* / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria
D005343:Fibrinolytic Agents