title: [Delay in management and treatment of patients with suspected acute myocardial infarction: role of the public, of extra- and intra-hospital structures and transportation methods].
abstract: The potential impact of thrombolytic agents on mortality and morbidity from coronary artery disease is weakened by in- and out-of-hospital delays occurring in the management of acute myocardial infarction. The goals of this study were to review the situation 5 years after the publication of the GISSI study. From October 1, 1991 to March 31, 1992, all the events occurring between symptom onset and in-hospital treatment were analyzed for 620 consecutive patients with suspected myocardial infarction seen in the emergency ward of the University Hospital, Geneva. Among them, 189 (30.5%) had myocardial infarction and 144 (23%) unstable angina. Mean and median delay between symptom onset and hospital arrival for the 620 patients were 10 h 02 min and 2 h 55 min respectively; 117 (19%) patients came straight to the hospital alone, with the risk of arrhythmic complications en route to the emergency ward but with shorter time delays (mean delay: 6 h 13 min; median delay: 2 h 30 min) than the 503 (81%) patients who called out-of-hospital services (mean delay: 10 h 55 min; median delay: 3 h; p < 0.04). The latter patients accounted for 47% of mean out-of-hospital delay and the out-of-hospital services for 53%. Minimization or ignorance of symptoms, waiting for relief from medication and attempts to reach relatives were responsible for long patients' decision times.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Clinique de médecine II, Hôpital cantonal universitaire, Genève.
authors.forename: J M
authors.initials: JM
authors.lastname: Gaspoz
authors.forename: P E
authors.initials: PE
authors.lastname: Unger
authors.forename: P
authors.initials: P
authors.lastname: Urban
authors.forename: J C
authors.initials: JC
authors.lastname: Chevrolet
authors.forename: W
authors.initials: W
authors.lastname: Rutishauser
authors.forename: H
authors.initials: H
authors.lastname: Giacobino
authors.forename: C
authors.initials: C
authors.lastname: Héliot
authors.forename: N
authors.initials: N
authors.lastname: Khatchatrian
authors.forename: F A
authors.initials: FA
authors.lastname: Waldvogel
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors; D014187:Transportation of Patients
vernacular_title: Délais dans la prise en charge et le traitement des patients avec suspicion d'infarctus aigu du myocarde: le rôle du public, des structures extra- et intra-hospitalières et des moyens de transports.