Document Detail


Call-to-needle times for thrombolysis in acute myocardial infarction in Victoria.
MedLine Citation:
PMID:  12697009     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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. DESIGN: Cohort study. SETTING: 20 hospitals and two ambulance services in the State of Victoria, Australia. PARTICIPANTS: 1147 patients with STEMI transported to hospital by ambulance and eligible for thrombolysis. MAIN OUTCOME MEASURES: 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. CONCLUSION: 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.
Authors:
Anne-Maree Kelly; Debra Kerr; Ian Patrick; Tony Walker
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Medical journal of Australia     Volume:  178     ISSN:  0025-729X     ISO Abbreviation:  Med. J. Aust.     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-16     Completed Date:  2003-06-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0400714     Medline TA:  Med J Aust     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  381-5     Citation Subset:  IM    
Affiliation:
Joseph Epstein Centre for Emergency Medicine Research, Western Hospital, Private Bag, Footscray, Victoria 3011, Australia. Anne-Maree.Kelly@wh.org.au
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Benchmarking / standards
Cohort Studies
Electrocardiography
Emergency Medical Services / standards*,  statistics & numerical data
Emergency Treatment / methods,  standards
Female
Fibrinolytic Agents / standards,  therapeutic use*
Guideline Adherence
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction / drug therapy*
Myocardial Reperfusion / methods*
Practice Guidelines as Topic / standards
Thrombolytic Therapy / methods*,  standards
Time Factors
Treatment Outcome
Victoria
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents
Comments/Corrections
Comment In:
Med J Aust. 2003 Apr 21;178(8):367-8   [PMID:  12697006 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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