[Acute myocardial infarction: time delay from onset of pain to hospital presentation and thrombolysis].
BACKGROUND
The efficacy of thrombolytic therapy in patients with myocardial infarction depends largely on the delay to initiation of treatment.


METHODS
From February 1996 to May 1997 we prospectively studied 175 patients hospitalised for acute chest pain and suspected coronary heart disease. We determined the delays between onset of pain and calling for medical help, hospital arrival and thrombolysis.


RESULTS
The median delay until hospital presentation was 3.1 hours, with no difference between male and female or younger and older patients. 35% of the patients arrived at the hospital within 2 hours, 38% within 2-6 hours and 27% after more than 6 hours. Most of the delay was caused by the patients (median 2.0 hours). Emergency doctors contributed 35 minutes, and transport to the hospital took 31 minutes. 99 patients (57%) were diagnosed with acute myocardial infarction. 53 (54%) fulfilled the criteria for thrombolysis and were so treated. The median overall delay from onset of pain to thrombolysis was 2.9 hours. 77% received treatment within 6 hours, and 23% within 6-12 hours after onset of pain. The median delay inside the hospital (door to needle) was 40 minutes.


CONCLUSIONS
75% of patients with acute chest pain arrived at the hospital within 6 hours of onset of symptoms. Most of the delay was caused by the patients themselves, a factor which needs to be improved by better education. Moreover, optimising in-hospital processes should further shorten the delay to thrombolysis.
Ritzmann
P
P
Abteilung Innere Medizin, Kantonsspital Schaffhausen.
Frey
R
R
Rüttimann
S
S
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D002637:Chest Pain; D003327:Coronary Disease / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy*; D012737:Sex Factors; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
D001241:Aspirin