Consultation before thrombolytic therapy in acute myocardial infarction

Abstract

The maximum benefit of thrombolytic therapy is obtained when drug is administered early after symptoms onset.1–4 Of all the delays impacting on time-to-thrombolytic treatment, in-hospital delay is often the longest.5,6 Despite recommendation of the National Heart Attack Alert Program that thrombolytic therapy be administered to eligible patients within 30 minutes of arrival at the emergency department,5 median door-to-drug time nationwide exceeds 45 minutes.7 Time-consuming emergency department protocols and practices may explain these unacceptable delays. One common practice is to request a “consultation” from another physician before initiating lytic therapy. This practice, at times of great value, may potentially delay clearly indicated treatment. Little is known about how often such consultation occurs and how it impacts on patient outcome. The aim of this study was to determine whether patients enrolled in the second National Registry of Myocardial Infarction (NRMI 2) for whom consultation was obtained before initiation of lytic therapy differ in presenting characteristics from their counterparts whose consultation was not obtained, to ascertain differences in time to treatment due to consultation, and to determine if time delays associated with consultation affect ultimate in-hospital outcome.