Fibrinolytic therapy in acute myocardial infarction: Time to treatment in Canada

Background: Fibrinolytic therapy has become the standard therapy for acute myocardial infarction with ST segment elevation. Many clinical trials have established that early administration of therapy correlates with improved outcomes. However, there are very few published data analyzing time to treatment in Canadian hospitals. Objectives: To examine all time intervals from onset of symptoms to treatment with fibrinolytic therapy in patients in Canada. Methods: Using the FASTRAK II database, time intervals in 11,574 patients treated with fibrinolytic therapy in 106 contributing institutions across Canada from 1998 to 2000 were studied. Variables contributing to long delays in starting fibrinolytic therapy were analyzed. Results: The mean time from onset of symptoms to arrival at hospital was 162 min (2.7 h). Only 6.3% of patients received fibrinolytic therapy within 1 h of symptom onset. Time from hospital arrival to acquisition of first 12 lead electrocardiogram was 14 min. Mean time from diagnositc electrocardiogram to decision to treat was 29.7 min, and time from decision to treat to administration of fibrinolytic therapy was 11 min. The overall average time from arrival at hospital to administration of fibrinolytic therapy was 69 min. Conclusion: In Canada, time from onset of symptoms to hospital presentation precludes early fibrinolytic therapy administration in the majority of cases. Time intervals from arrival in the emergency department to administration of fibrinolytic therapy are longer than the published and accepted standards. Strategies to alter health care seeking behaviour and to minimize in-hospital delays are needed.