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Emergency (2014);2(4): 150 150 

LETTER  TO EDITOR 
 

 

Door to Electrocardiography (ECG) and Needle Times in Patients with 

 Myocardial Infarction 

Mohammad Kalantari Meibodi* 

Emergency Medicine Trauma Research Center, Shiraz Medical University, Shiraz Iran  

*Corresponding Author: Mohammad Kalantari Meibodi; Department of Emergency Medicine, Nemazi Hospital, Zand Avenue, 
Zand Square, Shiraz 71937-11351, Iran. Tel/Fax: +98 9151132998; Email: kalantari_meibodi@yahoo.com 

 

 
Dear editor: 

cute myocardial infarction is one of the most 
prevalent causes of hospitalization in emergency 
department. In United States 650,000 patients 
annually suffer from acute myocardial infarction 

and in Iran ischemic heart diseases are considered as the 
second cause of mortality in population of 15-49 years 
(1). Taking thrombolytic drugs leads to 40-50% de-
crease in mortality rate of such patients. Based on the 
current standards, less than 10 and 30 minutes are esti-
mated for appropriate door to electrocardiography 
(ECG) and door to needle times, respectively (2). In a 
study performed on 100 patients referred to the emer-
gency department of Nemazi Hospital, Shiraz, Iran, 
through March 2013 to April 2014, the mean time from 
the chest pain starting to emergency ward admission 
was estimated more than 90 minutes. The mean time 
from admission to do ECG were 11 minutes at morning 
shift, 16 minutes at evening, and 23 minutes at night. 
Also, the mean time from admission to ECG performing 
and thrombolytic therapy (door to needle) were around 
two times more than standard times and no significant 
difference was seen among the morning, evening, and 
night shifts. The mean door to needle time in one hospi-
tal of Hamedan, Iran, was reported around 84 minutes, 
in Jahrom, Iran, 190 minutes, and in three hospitals in 
Tehran, Iran, 44 minutes (3-5). The findings of previous 
studies showed a significant relation between crowded-
ness of the work shift and longer treatment time in pa-
tients with myocardial infarction. Considering to the im-
portance of door to needle time in improving the final 
outcome and decreasing the mortality rate of patients 
with ischemic heart disease, planning and correct train-
ing of hospital and pre-hospital staffs are critical for ap-
proaching these mean times to international standards.  
References: 
1. Forouzanfar MH, Sepanlou SG, Shahraz S, et al. Evaluating 
causes of death and morbidity in Iran, global burden of 
diseases, injuries, and risk factors study 2010. Arch Iran Med. 
2014;17(5):304-20. 

2. Zalenski RJ, Selker HP, Cannon CP, et al. National Heart 
Attack Alert Program position paper: chest pain centers and 
programs for the evaluation of acute cardiac ischemia. Ann 
Emerg Med. 2000;35(5):462-71. 
3. Zeraati F, Homayounfar S, Esna-Ashari F, Khalili M. 
Fibrinolytic Therapy in CCU Instead of Emergency Ward: How 
It Affects Door to Needle Time? Int J Prev Med. 2014;5(3):308. 
4. Hojjat M. Time period between entrance of severe heart 
stroke patient to hospital and streptokinase injection by 
nurses. J Crit Care Nurs. 2009;2(1):35-9. 
5. Tabriz AA, Sohrabi M-R, Kiapour N, Yazdani S. Factors 
associated with delay in thrombolytic therapy in patients with 
ST-elevation myocardial infarction. J Tehran Heart Cent. 
2012;7(2):65-71. 

 

A 

mailto:kalantari_meibodi@yahoo.com