Fibrinolytic treatment in acute myocardial infarction: Analysis of delay times

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.