Point of entry treatment gives best time to thrombolysis for acute myocardial infarction.

The aim was to compare time to thrombolysis for patients treated via three treatment pathways: thrombolysis in the emergency department (ED), thrombolysis following direct admission by ambulance officers to coronary care (CCU) and thrombolysis after transfer from ED to CCU. We used a retrospective study of time to thrombolysis for all patients receiving thrombolysis for acute myocardial infarction (AMI) at Western Hospital during 1999. The median time to thrombolysis in the ED group was 30 minutes (mean 40 minutes), compared with 60 minutes for the CCU group (mean 63 minutes) and 40 minutes (mean 43 minutes) for the direct CCU admission group. Eighty-five percent of patients treated in ED received thrombolysis in less than 60 minutes compared with 21% of those transferred from the ED for treatment in CCU and 52% of those directly admitted to CCU. We conclude that point of entry thrombolysis, be it in ED or in CCU after direct admission, gives shorter times to thrombolysis than processes that require transfer of patients between departments.