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CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1996 Feb 15;154(4):483–487.

Recommendations for ensuring early thrombolytic therapy for acute myocardial infarction. The Heart and Stroke Foundation of Canada, the Canadian Cardiovascular Society and the Canadian Association of Emergency Physicians for the Emergency Cardiac Care Coalition.

PMCID: PMC1487599  PMID: 8630837

Abstract

OBJECTIVE: To recommend practical steps to ensure early thrombolytic therapy and thereby reduce mortality and morbidity associated with acute myocardial infarction (AMI). OPTIONS: Various factors were considered that influence time to thrombolysis related to patients, independent practitioners and health care systems. OUTCOMES: Reduction in morbidity and mortality associated with AMI. EVIDENCE: Early initiation of thrombolytic therapy reduces morbidity and mortality associated with AMI. The ECC Coalition analysed the factors that might impede early implementation of thrombolytic therapy. VALUES: Published data were reviewed, and recommendations were based on consensus opinion of the Emergency Cardiac Care (ECC) Coalition. The ECC Coalition comprises 20 professional, nongovernment and government organizations and has a mandate to improve emergency cardiac care services through collaboration. BENEFITS, HARMS AND COSTS: Early thrombolytic therapy reduces morbidity and mortality associated with AMI. Implementation of the recommendations will result in reduced time to thrombolytic therapy, streamlining of current practices and enhanced cooperation among health care professionals to expedite care. Depending on existing practices, implementation may require protocol development, and public and professional education. Although costs are associated with educating the public and health care professionals, they are outweighed by the financial and social benefits of reduced morbidity and mortality. RECOMMENDATIONS: Early recognition of AMI symptoms by the public and health care professionals, early access to the emergency medical services system and early action by emergency care providers in administering thrombolytic therapy (within 30 minutes after the patient's arrival at the emergency department). VALIDATION: No similar consensus statements or practice guidelines for thrombolytic therapy in Canada are available for comparison.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Birkhead J. S. Time delays in provision of thrombolytic treatment in six district hospitals. Joint Audit Committee of the British Cardiac Society and a Cardiology Committee of Royal College of Physicians of London. BMJ. 1992 Aug 22;305(6851):445–448. doi: 10.1136/bmj.305.6851.445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cooper R. S., Simmons B., Castaner A., Prasad R., Franklin C., Ferlinz J. Survival rates and prehospital delay during myocardial infarction among black persons. Am J Cardiol. 1986 Feb 1;57(4):208–211. doi: 10.1016/0002-9149(86)90892-1. [DOI] [PubMed] [Google Scholar]
  3. Gonzalez E. R., Jones L. A., Ornato J. P., Bleecker G. C., Strauss M. J. Hospital delays and problems with thrombolytic administration in patients receiving thrombolytic therapy: a multicenter prospective assessment. Virginia Thrombolytic Study Group. Ann Emerg Med. 1992 Oct;21(10):1215–1221. doi: 10.1016/s0196-0644(05)81749-4. [DOI] [PubMed] [Google Scholar]
  4. Grim P., Feldman T., Martin M., Donovan R., Nevins V., Childers R. W. Cellular telephone transmission of 12-lead electrocardiograms from ambulance to hospital. Am J Cardiol. 1987 Sep 15;60(8):715–720. doi: 10.1016/0002-9149(87)90388-2. [DOI] [PubMed] [Google Scholar]
  5. Kereiakes D. J., Gibler W. B., Martin L. H., Pieper K. S., Anderson L. C. Relative importance of emergency medical system transport and the prehospital electrocardiogram on reducing hospital time delay to therapy for acute myocardial infarction: a preliminary report from the Cincinnati Heart Project. Am Heart J. 1992 Apr;123(4 Pt 1):835–840. doi: 10.1016/0002-8703(92)90684-n. [DOI] [PubMed] [Google Scholar]
  6. Kereiakes D. J., Weaver W. D., Anderson J. L., Feldman T., Gibler B., Aufderheide T., Williams D. O., Martin L. H., Anderson L. C., Martin J. S. Time delays in the diagnosis and treatment of acute myocardial infarction: a tale of eight cities. Report from the Pre-hospital Study Group and the Cincinnati Heart Project. Am Heart J. 1990 Oct;120(4):773–780. doi: 10.1016/0002-8703(90)90192-z. [DOI] [PubMed] [Google Scholar]
  7. Leitch J. W., Birbara T., Freedman B., Wilcox I., Harris P. J. Factors influencing the time from onset of chest pain to arrival at hospital. Med J Aust. 1989 Jan 2;150(1):6–10. doi: 10.5694/j.1326-5377.1989.tb136310.x. [DOI] [PubMed] [Google Scholar]
  8. Moses H. W., Bartolozzi J. J., Jr, Koester D. L., Colliver J. A., Taylor G. J., Mikell F. L., Dove J. T., Katholi R. E., Woodruff R. C., Miller B. D. Reducing delay in the emergency room in administration of thrombolytic therapy for myocardial infarction associated with ST elevation. Am J Cardiol. 1991 Jul 15;68(2):251–253. doi: 10.1016/0002-9149(91)90754-9. [DOI] [PubMed] [Google Scholar]
  9. Rawles J. Halving of mortality at 1 year by domiciliary thrombolysis in the Grampian Region Early Anistreplase Trial (GREAT). J Am Coll Cardiol. 1994 Jan;23(1):1–5. doi: 10.1016/0735-1097(94)90494-4. [DOI] [PubMed] [Google Scholar]
  10. Sharkey S. W., Bruneete D. D., Ruiz E., Hession W. T., Wysham D. G., Goldenberg I. F., Hodges M. An analysis of time delays preceding thrombolysis for acute myocardial infarction. JAMA. 1989 Dec 8;262(22):3171–3174. [PubMed] [Google Scholar]
  11. Weaver W. D., Cerqueira M., Hallstrom A. P., Litwin P. E., Martin J. S., Kudenchuk P. J., Eisenberg M. Prehospital-initiated vs hospital-initiated thrombolytic therapy. The Myocardial Infarction Triage and Intervention Trial. JAMA. 1993 Sep 8;270(10):1211–1216. [PubMed] [Google Scholar]
  12. Weaver W. D., Eisenberg M. S., Martin J. S., Litwin P. E., Shaeffer S. M., Ho M. T., Kudenchuk P., Hallstrom A. P., Cerqueira M. D., Copass M. K. Myocardial Infarction Triage and Intervention Project--phase I: patient characteristics and feasibility of prehospital initiation of thrombolytic therapy. J Am Coll Cardiol. 1990 Apr;15(5):925–931. doi: 10.1016/0735-1097(90)90218-e. [DOI] [PubMed] [Google Scholar]
  13. Wielgosz A. T., Nolan R. P., Earp J. A., Biro E., Wielgosz M. B. Reasons for patients' delay in response to symptoms of acute myocardial infarction. CMAJ. 1988 Nov 1;139(9):853–857. [PMC free article] [PubMed] [Google Scholar]

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