Time delays to lytic therapy and outcome in 100 consecutive patients with a history suggestive of acute myocardial infarction in an area with access to a mobile coronary care unit

• Published in: European heart journal 1994-05, Vol.15 (5), p.594-601
• Main Authors: ROBERTS, M. J. D., MCNEILL, A. J., MACKENZIE, G., ADGEY, A. A. J.
• Format: Article
• Language: English
• Subjects: acute myocardial infarction; Ambulances - statistics & numerical data; Coronary Care Units - statistics & numerical data; Emergency Medical Services - statistics & numerical data; Female; Health Services Accessibility; Hospital Mortality; Humans; Lytic therapy; Male; Middle Aged; mobile coronary care unit; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Northern Ireland - epidemiology; Patient Acceptance of Health Care; Regression Analysis; Thrombolytic Therapy; time delays; Time Factors; Tissue Plasminogen Activator - therapeutic use
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/oxfordjournals.eurheartj.a060554

Time delays to fibrinolytic treatment and outcome were assessed in 100 consecutive patients, with suggestive symptoms and electrocardiographic changes of acute myocardial infarction, admitted to the coronary care unit of this hospital. All patients admitted from out-of-hospital had access to a mobile coronary care unit. Initially, 40 patients called a general practitioner, 30 called the ‘999’ operator, 12 called the mobile coronary care unit, 10 reported directly to the Accident and Emergency Department, seven were in-hospital and one spoke to the general practitioner's receptionist. Subsequently, 59 patients were attended by the mobile coronary care unit, 34 were admitted via the Accident and Emergency Department and seven had symptoms in-hospital. Thrombolytic therapy was initiated in 45159 (76%) patients by the mobile coronary care unit staff and in 29134 (85%) patients in the Accident and Emergency Department by cardiac staff. The remaining 26 patients received thrombolytic treatment in the hospital coronary care unit or cardiac department. The mean (± SEM) time from symptom onset to the initiation of thrombolytic therapy was 127 ( ± 11 min) for those patients treated by the mobile coronary care unit staff and for those treated in the Accident and Emergency Department was 187 (± 13 min) (P=0005). Multiple regression analysis showed significant reductions in total time delay if patients received thrombolytic therapy by the mobile coronary care unit staff out-of-hospital, when chest pain began in-hospital, or if patients had a previous myocardial infarction. Significant delays were noted for patients first attended by a general practitioner or among patients with a poor New York Heart Association Cardiovascular Class before symptoms suggestive of acute myocardial infarction. A similar pattern and severity of coronary artery disease was noted in these patients to that found by other workers: clinical re-infarction occurred in 14% and the in-hospital mortality was 8%. Thus, if the general practitioner attended the patient there was a significant increase in the delay to administration of thrombolytic therapy. Patients should receive lytic therapy where first assessed, if competent and adequately equipped staff are present.