Thrombolytic use in the region around Amarillo, Texas, in patients with ST elevation myocardial infarction.

Appropriate administration of thrombolytic therapy is particularly important for ST elevation myocardial infarction (STEMI) patients who are unable to access primary percutaneous coronary intervention (PCI) in a timely manner. We evaluated the current state of thrombolytic therapy in the Panhandle region of West Texas where access to primary PCI is poor. The medical records of 79 patients transferred from 20 outlying facilities to the two hospitals in Amarillo, Texas, for STEMI in 2016 were retrospectively evaluated for time of onset of chest pain, initial electrocardiogram findings, medication reconciliation, and any contraindications to thrombolytic therapy. Medical record review allowed the patients to be sorted into one of five predefined categories based on our findings. The most common error discovered was failure to deliver the appropriate accompanying medications with thrombolytic therapy, noted in 43% of patients. Other errors included failure to deliver thrombolytic therapy in patients who met no clear contraindications to thrombolytic therapy (21%) and administering thrombolytic therapy to patients who had not suffered STEMI (4%). Thirteen percent of patients were appropriately treated with thrombolytic therapy and 19% of patients met a contraindication to thrombolytic therapy and were not treated with thrombolytic therapy, as was appropriate.