Changing times in the treatment of myocardial infarction

James W Leitch
Med J Aust 2003; 178 (8): . || doi: 10.5694/j.1326-5377.2003.tb05250.x
Published online: 21 April 2003

Infarct angioplasty has the potential to increase the disparity in outcomes between rural and urban patients with myocardial infarction

The need for rapid treatment of coronary syndromes has been recognised for many years. Despite recent emphasis on the benefits of rapid thrombolysis, the main advantage of early presentation remains resuscitation from ventricular fibrillation. Defibrillation has been estimated to save about six times as many lives as thrombolytic treatment,1 but patients must reach medical assistance in time for it to be effective.

  • Department of Cardiology, John Hunter Hospital, Newcastle, NSW.


  • 1. Julian DG, Norris RM. Myocardial infarction: is evidence-based medicine the best? Lancet 2002; 359: 1515-1516.
  • 2. Kelly AM, Kerr D, Patrick I, Walker T. Call-to-needle times for thrombolysis in acute myocardial infarction in Victoria. Med J Aust 2003; 178: 381-385.<eMJA full text>
  • 3. Bett N. Thrombolytic therapy for myocardial infarction: the time factor. Med J Aust 1998; 168: 101-102.
  • 4. Goldberg RJ, Steg PG, Sadiq I, et al. Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry). Am J Cardiol 2002; 89: 791-796.
  • 5. Blohm MB, Hartford M, Karlson BW, et al. An evaluation of the results of media and educational campaigns designed to shorten the time taken by patients with acute myocardial infarction to decide to go to hospital. Heart 1996; 76: 430-434.
  • 6. Birkhead JS. Trends in the provision of thrombolytic treatment between 1993 and 1997. Heart 1999; 82: 438-442.
  • 7. Bryant M, Kelly AM. "Point of entry" treatment gives best time to thrombolysis for acute myocardial infarction. Aust Health Rev 2001; 24: 157-160.
  • 8. Sexton PT, Sexton TH. Excess coronary mortality among Australian men and women living outside the capital city statistical divisions. Med J Aust 2000; 172; 370-374.<eMJA full text>
  • 9. Morrison LJ, Verbeek PR, McDonald AC, et al. Mortality and prehospital thrombolysis for acute myocardial infarction. A meta-analysis. JAMA 2000; 283: 2686-2692.
  • 10. Feasibility, safety and efficacy of domicillary thrombolysis by general practitioners: Grampian region early anistreplase trial. GREAT group. BMJ 1992; 305: 548-553.
  • 11. Hansen PS, Rasmussen HH, Vinen J, Nelson GIC. A primary stenting strategy as an alternative to fibrinolytic therapy in acute myocardial infarction. Med J Aust 1999; 170: 537-540. <eMJA full text>
  • 12. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 2003; 361: 13-20.
  • 13. Bottiger BW, Bode C, Kern S, et al. Efficacy and safety of thrombolytic therapy after initially unsuccessful cardiopulmonary resuscitation: a prospective clinical trial. Lancet 2001; 357: 1583-1585.
  • 14. Pell JP, Sirel JM, Marsden AK, et al. Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study. BMJ 2002; 325: 515.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.