Early identification of acute myocardial infarction and prognosis in relation to mode of transport to hospital.
Of 2,840 consecutive patients who were admitted to the emergency department of a Swedish university hospital due to suspected acute myocardial infarction (AMI), only 25% were reached by the mobile coronary care unit (MCCU), and only 4% simultaneously fulfilled traditional criteria for prehospital thrombolysis (ie, had ST-segment elevation on admission electrocardiogram and a delay time of less than 6 hours). In the subset of patients who fulfilled criteria for a confirmed AMI, 31% were reached by an MCCU and 11% fulfilled criteria for prehospital thrombolysis. Among patients with confirmed AMI, the hospital mortality rate was highest in patients transported by standard ambulance (19%) versus 15% in those transported by an MCCU and 8% in those transported by other means. The authors conclude that AMI patients transported by ambulance are high-risk patients for early death. Prehospital thrombolysis might reduce their rate of mortality. However, according to the authors' experience only a minor fraction of patients are available for prehospital thrombolysis.
Herlitz
J
J
Department of Medicine I, Sahlgrenska Hospital, Göteborg, Sweden.
Karlson
B W
BW
Liljeqvist
J A
JA
Strömbom
U
U
Holmberg
S
S
D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D011379:Prognosis; D013548:Sweden / Q000453:epidemiology; D015912:Thrombolytic Therapy; D014187:Transportation of Patients / Q000379:methods*