Emergency physician versus cardiologist-initiated thrombolysis for acute myocardial infarction: a Singapore experience

I Irwani, CM Seet, PG Manning
Correspondence: Dr Irwani Ibrahim, irwani@nuh.com.sg

ABSTRACT
Introduction To compare the door-to-needle time between thrombolysis administration for patients with ST elevation myocardial infarction (STEMI) in the emergency department (EMD) by emergency physicians and those administered in the coronary care unit (CCU) by cardiologists.
Methods The data was collected prospectively for all patients with STEMI who received thrombolysis in the emergency department over a one-year period from January 2001 to December 2001. We recorded the time of arrival in the EMD as well as the time thrombolytic therapy was commenced. This data was compared to those from the previous year, obtained retrospectively, where the patients received thrombolysis in the CCU.
Results 118 patients were thrombolysed in the CCU and 78 patients were thrombolysed in the EMD. The median door-to-needle time was significantly shorter in patients who are thrombolysed in the emergency department by emergency physicians than in the coronary care unit by cardiologists (29 minutes versus 60 minutes, p value is less than 0.001). There was no incident of inappropriate thrombolysis nor was there intracranial or gastrointestinal bleed in the patients who were thrombolysed in the EMD. There was one case of medication dose error but it was of no consequence to the patient.
Conclusion Emergency physicians can administer thrombolytic treatment appropriately, quickly and safely in patients with STEMI.

Keywords: acute myocardial infarction, door-to-needle time, ST elevation, ST elevation myocardial infarction (STEMI), thrombolysis
Singapore Med J 2004; 45(7): 313-317