Impact of chest pain evaluation program on early thrombolysis in acute myocardial infarction

Early thrombolysis has increased survival in eligible patients with acute myocardial infarction (AMI). Therefore, early triage and short Door-To-Needle Time [DTNT, time of patient arrival in Emergency Department (ED) to time of thrombolysis] are most important. In a high volume tertiary care center (>500 beds), prompt attention to AMI patients can be delayed. Thus, we developed a Chest Pain Evaluation Program (CPEP). Prospective data on DTNT of consecutive thrombolysis treated patients prior to and after initiation of the CPEP are presented in 3 groups (GR). Pre-CPEP CPEP GR 1IN=45) GR 2(N=36) GR 3(N=36) Study Period 7/93-7/94 8/94-3/95 3/95-11/95 Median (min) 71 57 40 Range (min) 31-221 21-116 15-136 Two-Tailed P <0.03' <0.01 25,75th perc.(min) 50/98 38/73 29/58 Mann-Whitney U test; TGR1 vs GR 2; 'GR2 vs GR3; 'percentile Patients receiving thrombolysis above the 75th perc. of DTNT were considered "outliers", and observed 11x(GR1), 9x(GR2), and 9x(GR3). Causes of outliers were one or a combination of factors, as delay in 1) obtaining ECG (n=8), 2) diagnosis of AMI (n=10), and 3) decision for thrombolysis (n=23). Conclusion: CPEP has significantly decreased DTNT. Major determinants were systematic education of ED triage personnel and of responsible ED physician/nurse team, further, establishment of an in-hospital "911 system", to provide immediate cardiology service.