Call-to-needle times for thrombolysis in acute myocardial infarction in Victoria

Objective: To determine the proportion of patients in Victoria treated within the British Heart Foundation 90-minute call-to-needle (CTN) time benchmark for thrombolysis of ST-elevation myocardial infarction (STEMI), and to validate the British Heart Foundation 90-minute benchmark with respect to mortality. Design: Cohort study. Setting: 20 hospitals and two ambulance services in the State of Victoria, Australia. Participants: 1147 patients with STEMI transported to hospital by ambulance and eligible for thrombolysis. Main outcome measures: CTN time, and in-hospital mortality. Results: Median CTN time was 83 minutes (mean, 93.2 min; range, 29-894 min). Median door-to-needle (DTN) time was 37 minutes (mean, 46.5 min; range, 0-853 min). 61% of patients received thrombolysis within the 90-minute benchmark. Patients with CTN times > 90 minutes had an increased risk of dying (relative risk, 1.8; 95% Cl, 1.3-2.7). Factors associated with CTN time <90 minutes were lower DTN time, prior notification of the receiving hospital and transport time less than 20 minutes. Conclusion: The British Heart Foundation CTN time benchmark is being met for 61% of eligible STEMI patients in Victoria. Strategies to reduce CTN time should be region-specific, and should include attempts to reduce DTN and to enhance ambulance-hospital communication. Prehospital thrombolysis may be appropriate for some regions.