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

Med J Aust. 2003 Apr 21;178(8):381-5. doi: 10.5694/j.1326-5377.2003.tb05255.x.


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% CI, 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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Benchmarking / standards
  • Cohort Studies
  • Electrocardiography
  • Emergency Medical Services / standards*
  • Emergency Medical Services / statistics & numerical data
  • Emergency Treatment / methods
  • Emergency Treatment / standards
  • Female
  • Fibrinolytic Agents / standards
  • Fibrinolytic Agents / therapeutic use*
  • Guideline Adherence
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / drug therapy*
  • Myocardial Reperfusion / methods*
  • Practice Guidelines as Topic / standards
  • Thrombolytic Therapy / methods*
  • Thrombolytic Therapy / standards
  • Time Factors
  • Treatment Outcome
  • Victoria


  • Fibrinolytic Agents