The AUDIT Project: Factors Affecting Thrombolytic Therapy in 3,123 Patients With Acute Myocardial Infarction

Journal of Clinical and Basic Cardiology 2002; 5 (2): 183-188

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Keywords: akuter Myokardinfarkt,  Thrombolyse,  acute myocardial infarction,  clinical audit,  thrombolytic therapy

In the course of a year (16/09/1997 - 15/09/1998), the management of health care for patients with acute myocardial infarction (AMI) was audited in Slovakia. The questionnaire-based prospective multicenter study involved 66 departments treating AMI-patients and included 3123 patients, of whom 1074 (34.6 %) underwent thrombolytic therapy (TLT). This paper reports on factors influencing TLT under the specific conditions in Slovakia. The median time from onset of symptoms to treatment was 185 min, and the median time from arrival at the hospital to the beginning of treatment (door-to-needle time) was 30 min. Most frequently TLT-treated patients presented themselves in the hospital within 2 hours after onset of symptoms (58.3 %). Still, 29.9 % of patients arriving between 6 and 12 hours after onset of symptoms were nevertheless treated by TLT. The in-hospital delay was longer for patients with a history of repeated AMI, angina pectoris, or hypertension. With regard to age, sex, and diabetes, there was no difference in the duration of hospital delay. On the other side, the study has found a clear predominance of pre-hospital over hospital delay. We have also discovered a great potential for increasing TLT-administration to patients older than 64 years, women, and patients with repeated/next AMI as well as administering TLT in the night-time. Night-time TLT-administration has been hindered mainly by patient delay (median 120 min) and partly also by a prolongation of transportation time in the night (to a median of 59.5 min). The main factors for not accomplishing TLT were: late arrival into the hospital (more than 12 hours after symptoms onset, 34.9 %), uncertain indication of TLT (29.9 %) and contraindications (16.1 %).