UNDERUTILISATION OF THROMBOLYSIS IN THE NATIONAL ACS PROGRAMME; THE ST JAMES EXPERIENCE

Optimal reperfusion in STEMI is the key goal of the National ACS programme. The aims of the programme are a diagnosis to door time (DDT) of We used the Code STEMI database collected prospectively and HIPE data to identify our patient cohort. From January to December 2015 487 patients in total were identified as diagnosed with a STEMI or transferred to St James as part of the National ACS programme. Looking at all-comers; 222 (45%) were transferred from another hospital, 206 (42%) from the field, 29 (6%) from our ED. The average DDT of the patients from outside hospitals was 141 minutes (median 110, range 18–798), 63% were outside the 90 minutes DDT. The average RT was 148 minutes (median 128, range 25–599), 57% of the patients were outside the recommended 120 minutes for RT. Only 7 patients (1.4%) were thrombolysed prior to transfer. There are inevitable delays when arranging transfer of Code STEMI patients from an outside hospital to the primary PCI centre. It is expected that a proportion of patients will have to undergo thrombolysis as the initial reperfusion strategy. The data we collected in the largest PPCI centre in the country highlights that thrombolysis is being under-utilised and needs to be considered in all inter-hospital STEMI transfers.