IMPACT OF A THROMBOLYSIS RESEARCH TRIAL ON TIME TO TREATMENT FOR ACUTE MYOCARDIAL-INFARCTION IN THE EMERGENCY DEPARTMENT

Time from onset of symptoms of acute myocardial infarction (AMI) to treatment with thrombolytic therapy is a critical determinant in infarct size and mortality.(1-7) After initial reports of the importance of time to treatment in AMI, many hospitals introduced protocols to reduce the time from arrival in the emergency department (ED) to the start of thrombolytic therapy, termed the ''door-to-needle'' time.(8-11) Initially these protocols, along with increased general awareness, resulted in a reduction of time to treatment.(11-13) However, despite considerable attention and effort, further reductions have been difficult to accomplish.(14) In an effort to improve the rate and stability of reperfusion, multiple new thrombolytic and antithrombotic regimens are being studied. The Thrombolysis in Myocardial Infarction (TIMI) 5 trial was a randomized trial of hirudin, a new specific thrombin inhibitor versus heparin in conjunction with tissue plasminogen activator for patients with AMI.(15) It was a complex, labor-intensive trial with extensive inclusion/exclusion criteria, a 5-page consent form, telephone randomization, a bolus of hirudin or heparin before initiation of thrombolytic therapy, and early angiography. There was considerable concern that this process would add significant delays to time to treatment. We therefore examined the effect of the TIMI 5 trial on time to treatment of patients with AMI admitted to the ED in the 2 hospitals enrolling patients in Minneapolis, Minnesota.