956-115 Method of Reducing Emergency Room Time to Treatment for Acute Myocardial Infarction

Kopecky, Stephen L.; Siska, Martha; Jurek, Jean; Gudgell, Stephen F.; Meloy, Thomas D.; Fischer, Deborah R.; Reeder, Guy S.

doi:10.1016/0735-1097(95)92312-s

Cited by 3 publications

(3 citation statements)

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“…These are the four critical time points in evaluating the patient for thrombolysis: the time between hospital arrival (door), ECG acquisition (data), assessment of eligibility for thrombolysis (decision), and administration of thrombolytic therapy (drug). Using the 4 Ds has been extremely useful in reducing in-hospital treatment delays, as evidenced by several recent reports [28,[54][55][56].…”

Section: Onset Ofmentioning

confidence: 98%

Time to reperfusion: The critical modulator in thrombolysis and primary angioplasty

Cannon

Braunwald

1996

J Thromb Thrombol

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Rapid achievement of reperfusion with thrombolytic therapy or primary angioplasty has made a dramatic impact an improving the survival of patients with acute myocardial infarction (MI). Restoring infarct-related artery patency early after the onset of MI minimizes infarct size, reduces the degree of left ventricular dysfunction, and improves survival. Several recent studies have confirmed the benefit of reducing time to treatment with thrombolysis (between the onset of pain to initiation of thrombolysis), and that of more rapid drug reperfusion time with more aggressive thrombolytic regimens (between initiation of thrombolytic therapy and actual achievement of reperfusion). Furthermore, these effects are additive, confirming the benefit of rapid reperfusion. For primary angioplasty, the same relationship has been observed-more rapid treatment appears to be associated with improved outcome. The "door-to-balloon" time is a major determinant of overall time to reperfusion, and as such is a crucial component of the overall strategy. Integrating the experience in trials of thrombolytic therapy and primary angioplasty, a clear relationship exists between higher rates of early reperfusion and lower mortality. Thus, time to reperfusion appears to be the critical modulator in both thrombolysis and primary angioplasty.

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Section: Onset Ofmentioning

confidence: 98%

Time to reperfusion: The critical modulator in thrombolysis and primary angioplasty

Cannon

Braunwald

1996

J Thromb Thrombol

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“…These are the four critical time points in evaluating the patient, for thrombolysis: the time between hospital arrival (Door) and the time the ECG is taken (Data), how long it takes the physician to decide whether the patient is eligible for thrombolysis (Decision), and how long it takes to have the drug mixed up and administered (Drug). Using the 4 Ds has been extremely useful in reducing in-hospital treatment delays, as evidenced by several recent reports [28][29][30][31] (Figure 4). ......................................... [18] and Gersh and Anderson [26], with permission.…”

Section: Improving Time To Treatmentmentioning

confidence: 99%

“…In addition, at each time period, use of a thrombolytic agent that opens arteries more rapidly (t-PA as compared with streptokinase) was associated with an added reduction in mortality. Thus, as would be expected based on the open artery theory, efforts to reduce time to treatment will work in concert with the use of more rapidly acting throm- [42], Cannon et al [28], Kopecky et al [31], and Lambrew [29].) bolytic agents to together reduce mortality.…”

Section: Drug Reperfusion Timementioning

confidence: 99%

Time to treatment: A crucial factor in thrombolysis and primary angioplasty

Cannon

1996

J Thromb Thrombol

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Time to treatment with thrombolytic therapy has been recognized as an important factor in the treatment of patients with acute myocardial infarction: By restoring infarct-related artery patency earlier, clinical outcome is improved. Of the several components of time delay between the onset of pain to opening of the artery, in-hospital time delay (i.e., the door-to-needle time) is one that physicians can control the most, with improvements being reported with the use of a myocardial infarction (MI) protocol like the one advocated by the National Heart Attack Alert Program. These same principles apply to the alternate reperfusion strategy, primary angioplasty. Indeed, while primary angioplasty has been shown to be beneficial in early clinical trials, it appears that the "door-to-balloon" time is a crucial component of the overall strategy. Thus, a growing body of evidence demonstrates that time to treatment is a crucial factor in both thrombolysis and primary angioplasty.

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Multimodality reperfusion therapy for acute myocardial infarction

Cannon

2000

American Heart Journal

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956-115 Method of Reducing Emergency Room Time to Treatment for Acute Myocardial Infarction

Cited by 3 publications

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Time to reperfusion: The critical modulator in thrombolysis and primary angioplasty

Time to reperfusion: The critical modulator in thrombolysis and primary angioplasty

Time to treatment: A crucial factor in thrombolysis and primary angioplasty

Multimodality reperfusion therapy for acute myocardial infarction

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