Emergency department thrombolysis critical pathway reduces door-to-drug times in acute myocardial infarction

Clin Cardiol. 1999 Jan;22(1):17-20. doi: 10.1002/clc.4960220108.


Background: Rapid time to treatment with thrombolytic therapy is an important determinant of survival in acute myocardial infarction (AMI).

Hypothesis: We hypothesized that establishment of an AMI thrombolysis critical pathway in the Emergency Department could successfully reduce the "door-to-drug" time, the time between patient arrival and start of thrombolysis.

Methods and results: Before establishment of the AMI critical pathway, median door-to-drug time was 73 min, which was reduced to 37 min after critical pathway implementation (p < 0.05). The percentage of patients treated within 30 min rose from 0% prior to establishment of the pathway to 43% (p = 0.03). Similarly, the percentage treated in within 45 min rose from 0 to 67% (p = 0.0005). Door-to-drug times were longer for women than for men (median 105 min for women vs. 70 min for men before pathway implementation). The pathway reduced door-to-drug time for both genders, but the median door-to-drug times were higher for women than for men (Mann-Whitney p = 0.013). The difference between men and women was 35 min before establishment of the pathway to 10 min by the end of the study period.

Conclusions: Our critical pathway was successful in reducing door-to-drug times. We observed a "gender gap" in door-to-drug times, with longer mean times for women, which was reduced by the AMI critical pathway. Thus, our data provide support for the use of critical pathways to reduce door-to-drug times, as recommended by the National Heart Attack Alert Program.

Publication types

  • Comparative Study

MeSH terms

  • Critical Care / organization & administration
  • Critical Care / standards
  • Electrocardiography
  • Emergency Service, Hospital* / organization & administration
  • Emergency Service, Hospital* / standards
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Follow-Up Studies
  • Humans
  • Male
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / drug therapy*
  • Myocardial Infarction / mortality
  • Patient Admission / standards
  • Retrospective Studies
  • Sex Factors
  • Survival Rate
  • Thrombolytic Therapy*
  • Time Factors
  • Treatment Outcome


  • Fibrinolytic Agents