Thrombolysis versus primary percutaneous coronary intervention for ST elevation myocardial infarctions at Chilliwack General Hospital.

BACKGROUND: Studies have shown that primary percutaneous coronary intervention (PCI), when performed by an experienced operator immediately after admission in a high-volume tertiary care centre, results in lower in-hospital mortality, and decreased risk of reinfarction and stroke. Furthermore, for those communities without a PCI centre, transport of patients to a PCI centre within 90 min is superior to thrombolysis. Chilliwack General Hospital (CGH, Chilliwack, British Columbia) has a unique situation - the travel time to the nearest coronary catheterization centre (Royal Columbian Hospital, New Westminster, British Columbia) is between 60 min and 120 min.

OBJECTIVES: To compare access to and use of thrombolysis versus PCI in individuals with ST elevation myocardial infarctions (STEMIs) at CGH.

METHODS: A retrospective chart review was conducted on patients who presented to the emergency department at CGH with STEMIs between January 1, 2004, and December 31, 2005. Of the 67 patients who had a STEMI during this time period, 40 patients met inclusion criteria, of whom, 32 received thrombolytics and eight received PCI.

RESULTS: The average door-to-thrombolysis time was 46 min (95% CI 32 min to 60 min). A door-to-thrombolysis time of less then 30 min was achieved in 15 of 32 patients (47%). The average door-to-balloon time was 186 min (95% CI 166 min to 206 min). A door-to-balloon time of less than 90 min was not achieved in any of the eight patients who received PCI.

CONCLUSIONS: CGH did not meet the American Heart Association guidelines for a door-to-balloon time of less than 90 min.