Alfred Hospital Coronary Care Unit: an acute myocardial infarction quality assurance study.

A six-month prospective study was performed to assess the efficacy of delivering thrombolytic therapy to patients with acute myocardial infarction and admitted to the coronary care unit. Patient characteristics, time from chest pain onset to presentation to emergency department, from presentation to thrombolytic therapy, transfer from emergency department to coronary care unit major interventions and outcome were assessed. One hundred and twenty patients were admitted with acute myocardial infarction, mean age 66 years (26-91), 69% were males. Of these, 50% received thrombolytic therapy. The mean time from chest pain onset to emergency department was 192 +/- 164 minutes, transfer from emergency department to coronary care unit was 195 +/- 150 minutes. The mean time from presentation to emergency department to receiving thrombolytics was 63 +/- 12 minutes. Streptokinase was the choice of thrombolytic in 97%. Thrombolytic therapy was administered in emergency department in 80% of cases. Thirty-eight (63%) patients received thrombolytic therapy within 60 minutes of presentation. Compared to the non-thrombolytic group, the thrombolytic group were younger, 63 vs 69 years, P < 0.01, presented earlier to hospital (192 vs 394 minutes, P < 0.0005), were transferred to coronary care unit sooner (195 vs 472 minutes, P < 0.001), and had more coronary angiograms (29 vs 23, P < 0.02) and PTCA performed 10 vs 3, P < 0.04. There were no significant differences in length of coronary care unit stay, length of hospital stay, patients receiving CABG or death.