Acute myocardial infarction: delay from onset of pain to hospital presentation and thrombolysis

Background: The efficacy of thrombolytic therapy in patients with myocardia l infarction depends largely on the delay to initiation of treatment. Methods: From February 1996 to May 1997 we prospectively studied 175 patien ts 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 n o 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 a nd 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 minut es. 99 patients (57%) were diagnosed with acute myocardial infarction. 53 (54%) fulfilled the criteria for thrombolysis and were so treated. The median ov erall 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. Th e 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 pa tients themselves, a factor which needs to be improved by better education. Moreover, optimising in-hospital processes should further shorten the dela y to thrombolysis.