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March 19, 1994BMJ

Guidelines for the early management of patients with myocardial infarction

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Population

Patients suffering acute myocardial infarction

Design

Guideline

Authors

CWClive WestonGeneral CardiologyWPW J PennyYale UniversityDJDesmond G. JulianNewcastle upon Tyne Hospital

Discussion

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Overview

Sets 90-minute call-to-needle thrombolysis as the benchmark for eligible AMI; extends coordinated pre-hospital protocols into routine clinical and quality-improvement standards.

Key Points

  • To outline clinical recommendations defining the responsibilities of primary care, emergency services, and hospitals for the immediate management and timely reperfusion of acute myocardial infarction.
  • Convened an expert working group under the British Heart Foundation to review evidence on resuscitation and pre-hospital care.
  • Defined structural protocols for general practitioners, ambulance staff, and hospital emergency teams.
  • Established a benchmark standard requiring indicated patients to receive thrombolytic therapy within 90 minutes of alerting medical or ambulance services (call-to-needle time).
  • Identified critical pathways to achieve this timeline, including direct coronary care unit admissions, emergency department fast-track triage, and GP-initiated pre-hospital thrombolysis.

Structured PICO

P
Population
Patients suffering acute myocardial infarction
I
Intervention
Early management including rapid provision of basic and advanced life support, adequate analgesia, accurate diagnosis, and thrombolytic treatment (target call-to-needle time within 90 minutes)

The British Heart Foundation guidelines establish a 90-minute call-to-needle time standard for thrombolysis in acute myocardial infarction, emphasizing the critical role of coordinated pre-hospital and hospital care.

Cite This Study

Weston et al. (1994) studied this question.

synapsesocial.com/papers/6a7da3986ef7ec97ba7d868bhttps://doi.org/10.1136/bmj.308.6931.767
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Role of the general practitioner in managing patients with myocardial infarction: impact of thrombolytic treatment. Report of a British Heart Foundation Working Group.1989 · 22 citations
  2. 2Time delays in provision of thrombolytic treatment in six district hospitals. Joint Audit Committee of the British Cardiac Society and a Cardiology Committee of Royal College of Physicians of London.1992 · 125 citations
  3. 3Effect of "fast track" admission for acute myocardial infarction on delay to thrombolysis.1992 · 117 citations
  4. 4Early reporting of myocardial infarction: impact of an experiment in patient education.1982 · 54 citations
  5. 5Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: A comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge.1987 · 2,255 citations