EFFECT OF TIME FROM ONSET TO COMING UNDER CARE ON FATALITY OF PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION - EFFECT OF RESUSCITATION AND THROMBOLYTIC TREATMENT
Rm. Norris et al., EFFECT OF TIME FROM ONSET TO COMING UNDER CARE ON FATALITY OF PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION - EFFECT OF RESUSCITATION AND THROMBOLYTIC TREATMENT, HEART, 80(2), 1998, pp. 114-120
Objective-To examine the relation between time from onset of symptoms
and coming under ambulance and hospital care on fatality in patients w
ith evolving acute myocardial infarction, and on the proportions who s
urvive because of resuscitation and thrombolytic treatment. Design-Pro
spective community and hospital study over two years. Delay was measur
ed from the onset of symptoms to arrival at hospital, and from the ons
et to coming under care from ambulance personnel. Setting-Four general
hospitals serving three United Kingdom health districts. Patients-221
3 patients under 75 years of age, 111 of whom had been successfully re
suscitated from out of hospital cardiac arrest. Interventions-Resuscit
ation from cardiac arrest; thrombolytic treatment. Main outcome measur
es-30 day fatality and lives saved by the two forms of treatment. Resu
lts-Times from symptom onset to coming under hospital care and to star
ting thrombolytic treatment (given to 53% of patients) were less than
or equal to 1 hour in 15% and 2% of patients respectively, less than o
r equal to 2 hours in 54% and 25%, and less than or equal to 4 hours i
n 67% and 55%. Overall, 30 day fatality was 138/1000 patients treated;
64/1000 (95% confidence interval 54 to 74) survived because of treatm
ent, and 80% of this salvage was attributable to resuscitation. Delay
was an important factor: 107/1000 (60 to 144) lives were saved for tho
se coming under care within 1 hour compared with 21/1000 (5 to 37) for
those who delayed for more than 12 hours. Further analysis including
the 111 patients with out of hospital arrest showed that 34% of those
coming to hospital by ambulance came under ambulance care within 1 hou
r; for this subset, 30 day fatality was 173/1000, and 136 (109 to 163)
lives were saved by treatment. Conclusions-Results of treatment are s
trongly related to delay in coming under care. Reduction in delay can
reduce mortality from acute myocardial infarction.