Thrombolysis for acute myocardial infarction in Australasia 1999

Objective: To describe revascularization practice for acute myocardial infarction in a sample of Australasian hospitals during 1999. Design: Survey for the 1999 calendar year. Setting: Hospitals with Australasian College for Emergency Medicine-accredited emergency departments in Australia and New Zealand. Participants: Forty-eight hospitals of 80 surveyed (60%), comprising 15 tertiary and 33 non-tertiary hospitals. Main outcome measures: Time from arrival in emergency department to initiation of thrombolytic therapy, site of therapy, agent used, mortality and intracranial haemorrhage rates. Results: Approximately 30% of patients with acute myocardial infarction had revascularization therapy. Sixty-two per cent of patients receiving thrombolytics were given this treatment in the emergency department, the remainder in the coronary care unit. Overall median door-to-needle times were 35.0 min emergency department versus 48.3 min coronary care unit. Streptokinase was used for 58.3% of thrombolysis. In-hospital mortality of thrombolysed patients was 6.7% in the emergency department versus 4.3% in the coronary care unit with intracranial haemorrhage rates of 0.8% emergency department and 0.7% coronary care unit. Conclusions: Overall times to thrombolysis and outcome rates in this sample were within internationally reported figures. Emergency department times were shorter than in coronary care unit.