title: [Evaluation of treatment of acute myocardial infarction before admission to a coronary care unit].
abstract: A fact-finding survey was conducted to ascertain the treatment of 298 patients with acute myocardial infarction (AMI) who were referred to our coronary care unit (CCU) from other medical facilities between May 1978 and December 1987. The controls consisted of 169 patients with AMI who were admitted directly to our CCU during the same period. The mean time from onset of AMI to admission to our CCU was 21.7 +/- 67.9 hours (mean +/- SD) for patients from other medical facilities, and it took longer than that of the controls (11.7 +/- 34.9 hours). However, the mortality was 19.8%, being lower than that of the controls (26.0%). By the Killip's classification, there was no significant differences between both patient groups who belonged to Killip groups I, II and IV, but the mortality of cases in Killip group III was 3.7%, which was lower than that of the controls (7.15%). Among the 298 cases, 169 (56.7%) had received some kind of emergency treatment, and their mortality was 29.9%. However, the mortality of the remaining 129 cases (43.3%) who had received no emergency treatment was only 17.1%. The reason for this contradictory result is attributed to the fact that the former group included relatively severe cases. The number of patients receiving emergency treatment has gradually increased recently; however, the overall results achieved were not satisfactory even with appropriate therapy. Since April 1984, conferences with local practitioners have been held concerning emergency treatment for ischemic heart disease. This resulted in better understanding of CCU among the practitioners, less time delay until admission, and increased frequency and higher quality of emergency treatment. However, the mortality in the CCU did not decline, probably because of the relatively high rate of severe cases. To reduce mortality of AMI, a communication network should be established between practitioners and the CCU.
authors.affiliation: Second Department of Internal Medicine, Toho University School of Medicine, Tokyo.
authors.forename: Y
authors.initials: Y
authors.lastname: Mizobe
authors.forename: T
authors.initials: T
authors.lastname: Ohishi
authors.forename: T
authors.initials: T
authors.lastname: Yasukawa
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002047:Buprenorphine / Q000627:therapeutic use; D003325:Coronary Care Units; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification / Q000401:mortality / Q000628:therapy*; D009294:Narcotics / Q000627:therapeutic use
chemical_list: D000889:Anti-Arrhythmia Agents; D009294:Narcotics; D002047:Buprenorphine