[The prehospital phase of acute myocardial infarct and its significance for thrombolytic therapy].
Early thrombolytic therapy has become the treatment of choice for acute myocardial infarction (AMI). Of 189 patients admitted with AMI to the CCU of Berne University Hospital in 1988, only 17 (9%) underwent thrombolytic treatment. 101 patients (53%) were admitted within 4 hours after onset of symptoms. Early arrival (less than 4 hours) was significantly more frequent among patients admitted without prior medical consultation (76%, p less than 0.001), patients less than 65 years of age (67%, p less than 0.001), patients sustaining AMI outdoors (74%, p less than 0.005) and patients without a history of typical angina (71%, p less than 0.05). In all subgroups analyzed more than half of the prehospital delay (2.8 hours) was due to the patients' indecision whether to seek medical help; prehospital consultation by a general practitioner took 66 minutes and transportation arrangements 30 minutes; in-hospital delay from admission to intensive care treatment amounted to 72 minutes (39 minutes for arrival less than 4 hours; all median times). Overall in-hospital mortality was 16.6%. Mortality during a follow-up period of 4-16 months (overall 8.4%) was higher for patients with reinfarction (15.2%, p less than 0.05) and patients arriving with a delay greater than 4 hours (12.5%, p = 0.08). Combined mortality was 25% among 172 conservatively treated patients vs 0/17 among patients undergoing thrombolytic treatment (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Rapold
H J
HJ
Kardiologische Abteilung, Inselspital, Bern.
Dürkopp
A
A
Weiss
M
M
D000208:Acute Disease; D000368:Aged; D004632:Emergency Medical Services; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D012017:Referral and Consultation; D013557:Switzerland / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors
Die Vorspitalphase des akuten Myokardinfarktes und ihre Bedeutung für die thrombolytische Therapie.