Time to Thrombolysis in Patients with Acute Myocardial Infarction in a Tertiary Referral Centre : An Important Performance Indicator in an Emergency Department

摘要

Acute myocardial infarction (AMI) is amongst thetopmost medical emergencies presenting to theEmergency Department (ED) in which every singleminute is of immense value. Early thrombolytic therapyis the cornerstone of the treatment of AMI.1 Prompttreatment of patients with AMI decreases death fromearly arrhythmias and maximizes potential benefit ofthrombolytic therapy.2-4 Very early treatment with athrombolytic agent results in a substantial (30-70%)reduction in infarct size. More than half of this effect islost when the treatment is delayed by more than 60-75minutes.5 In India, the pre-hospital emergency medicalservices are not developed and pre-hospitalthrombolysis is not established. Hence most of thepatients having AMI receive thrombolysis only afterreaching the secondary or tertiary level hospitals whereIntensive Coronary Care Units (ICCU) are available.Limited number of tertiary referral hospitals in Indiahave a comprehensive ED fully equipped to administerthrombolytic therapy to patients with AMI. Since AMI isa major health problem and the outcome depends on thepromptness of thrombolytic therapy, we studied the timeto thrombolysis in patients with AMI as a performanceindicator (PI) of the ED at a tertiary referral hospital inMumbai city with a turnover of over 600 patients perday. Most of such studies have been conducted in thedeveloped world where greater awareness, availabilityof helplines and prompt ambulance services areavailable. No studies on PI in the EDs are available fromIndia, as the practice and documentation of qualityparameters is not in place in most of the EDs in India.