How much do we gain by reducing time to reperfusion therapy?
Emphasis continues to be placed on the need to minimize the time elapsed between the onset of symptoms of myocardial infarction and the initiation of thrombolytic therapy. Numerous large-scale trials have revealed an inverse relation between time-to-treatment and the degree of reduction in the risk of adverse clinical outcomes. Still to be resolved is the question of whether additional benefit can be gained by treating within the first hour. Many factors that influence delays to presentation are also associated with a higher risk of mortality, and these factors vary with patient characteristics. These same factors are also associated with longer treatment delay and greater mortality risk. Although the greatest opportunity for reducing time-to-treatment lies in reducing presentation time, public education efforts have been largely unsuccessful. Despite the fact that treatment delay generally accounts for a smaller proportion of total delay time than does presentation delay, it may be more amenable to shortening through measures such as transmission of electrocardiograms from the field; emergency department protocols for the rapid triage, assessment, and treatment of patients with chest pain; training emergency department physicians to administer thrombolytic therapy without a cardiology consult; and storing thrombolytic agents in the emergency department.
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