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Clinical factors associated with delay time in suspected acute myocardial infarction Bjijrn W. Karlson, Johan Herlitz, Margareta Sjiilin, Hans-Eric Ekvall, Nils Gunnar Persson, Jonny Lindqvist, and Ake Hjalmarson. Giiteborg,

Sweden

The early phaseof suspectedacute myocardial infarction (AMI) is particularly critical, During the two last decades, several reports have addressedthe issueof delay time in AMI; most of thesereports were published in the late 1960s and early 1970s.In severalof thesestudiesit wasfound that From the Division of Cardiology, Department of Medicine I, Sahlgrenska Hospital, and Gateborgs Datacentral. This study was supported by grants from the Swedish Heart Foundation; Arbetsmarknadens Farslkringsaktiebolag; The Gothenburg Society of Medicine; Skandia Insurance Co.; Trygg Hansa Insurance Co.; Ollie and Elof Ericsson’s Foundation; Leo and Hans Osterman’s Fund; and SjukfijrsCkrings AB Eire’s 50.grs Foundation. Reprint requests: Johan Herlitz, MD, Division of Cardiology, Department of Medicine I, Sahlgrenska Hospital, S-413 45 Gateborg, Sweden. 414123569

patients with a previous history of ischemic heart disease had a similar and sometimeseven longer delay time than patients without sucha history, indicating that patient education doesnot seemto influence delay time.le3These experienceshave been used as arguments against mounting large-scaleefforts such as systematic public information programswith the intention to further reduce patient delay in suspectedAMI. The encouragingexperiencesfrom early intervention studies in AM1 with P-blockers, and particularly with thrombolysis, have increasedthe interest in delay time and the possibility of reducing it. The aim of this communication is to give a comprehensive report of delay time between the onset of symptoms and arrival in the hospital amongpatients with confirmed AM1 admitted to the coronary care unit (CCU) aswell as to other wards from the emergency room in Sahlgrenska hospital during a period of 21 monthsin the late 1980s.This hospital coversthe central part of the city of Goteborg, i.e., a population of 250,000inhabitants. This meansthat there isno long-distancetransportation of patients involved. The observations were related to patient clinical history, the modeof transport to the hospital, the initial degreeof suspicion of AMI, the occurrenceof initial ST segmentelevation, the development of Q waves, and estimated infarct size. The information was prospectively recorded before

Median delay time (hrs)

5

4 3.5

2.4

2

2.6

i 0.9

51-60 61-70 Age (years) Fig. 1. Median delay time in patients with confirmed AM1 (N = 908) in relation to age.Figures represent number of patients and figures over bars represent median delay time in hours.

in bars

1213

12 14

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Table I. Delay time in patients with confirmed myocardial infarction in relation to clinical history, mode of transport to hospital, ECG findings on admission, and estimated infarct size (N = 908) Median delay time hr

min

Percentage after P

12 hr

%6 hr

No (712)

3

Any cardiovascular diseaset or diabetes Yes (647) 3 No (246)

3

Angina pectoris or myocardial infarction Yes (508) 3 No (400)

3

Transported by ambulance Yes (543) No (324)

68 65

30 12

45 30

70 61

43 38

75 64

22 00

36 43

67 67

00 15

43 38

70 66

Estimated infarct size SGOT max 5 median (441) SGOT max > median (439)

41 40

68 67

infarction,

Congestive heart failure Yes (27) No (337)

00 12

39 40

72 66

10 7

39 40

68 65

38 42

69 65

2 5

25 30

3

30 40

3 3

0 20

Clinical factors associated with delay time in suspected acute myocardial infarction.

BRIEF COMMUNICATIONS Clinical factors associated with delay time in suspected acute myocardial infarction Bjijrn W. Karlson, Johan Herlitz, Margareta...
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