Improving the management of acute myocardial infarction

The introduction of a national service framework for coronary heart disease in England and Wales was driven by evidence based medicine. Health service managers argued that clinicians were not reaping the proved benefits of interventions because of poor organisation. One good example of this is the use of thrombolysis in acute myocardial infarction.1 The delivery of thrombolytic agents during acute myocardial infarction is a well recognised and effective treatment, which has beneficial effects on mortality in both the short and the long term,2 and the earlier this treatment is given the greater the benefit. The focus on early administration of thrombolytic drugs led to the concept of “door to needle” time, with a target of 30 minutes, and a “call to needle” time of 60 minutes, incorporating the ambulance response time. But confusion still exists among many doctors about the absolute and relative contraindications to thrombolysis.3 …