Fibrinolytic Therapy in CCU Instead of Emergency Ward: How It Affects Door to Needle Time?

Abstract

Background:The door-to-needle-time (DNT) is considered a
standard time for scheduling thrombolysis for acute ST-segment elevation of myocardial infarction and this time can be reduced by minimizing the delay in starting thrombolytic treatment once the patient has reached to the hospital. This study was carried out on a sample of Iranian patients with acute myocardial infarction to determine the DNT in those after changing schedule of thrombolysis during 8 years from emergency to coronary care unit (CCU).
Methods:A descriptive cross-sectional study was carried out on all consecutive patients with a confirmed diagnosis of acute
myocardial infarction admitted to the emergency ward of Ekbatan Hospital in Hamadan, Iran, within 2011 and had an indication of fibrinolytic therapy, which 47 patients were finally indicated to receive streptokinase in the part of CCU.
Results:The mean time interval between arrival at the hospital and electrocardiogram (ECG) assessment was 6.30 min, taking ECG and patient’s admission was 21.6 min and transferring the patient from admission to CCU ward was 31.9. The time between transferring the patients to CCU ward and fibrinolytic administration order and the time between its ordering and infusion was 31.2 min and 14.0 min respectively. In sum, the DNT was estimated 84.48 ± 53.00 min ranged 30-325 min that was significantly more than standard DNT (P<0.01). Furthermore, DNT mean in this study is significantly more than a study conducted 8 years ago in the same hospita l (P<0.01).
Conclusions:The DNT is higher than the standard level and
higher than the estimated level in the past. This shows that DNT was longer after transferring to CCU.
Keywords:Door to needle time, fibrinolytic, myocardial infarction