| Abstract: | OBJECTIVES: To compare the components of the time delay involved in pre-hospitaland hospital thrombolytic therapy in patients presenting withsuspected acute myocardial infarction. MATERIAL AND METHODS: From October 1988 to January 1992 a total of 198 mobile emergencyunits in 15 European countries and Canada randomized 5469 patientsto receive either pre-hospital thrombolytic treatment, followedby placebo in hospital (pre-hospital group), or pre-hospitalplacebo, followed by thrombolytic treatment in hospital (hospitalgroup) in the European Myocardial Infarction Project trial.We performed a post hoc analysis of these data to correlatecomponents of the interval between symptom onset and treatmentwith baseline patient characteristics. RESULTS: The delay between onset of symptoms and calling for an ambulancewas significantly longer for female patients (P0·0001),older patients (>65 years old; P=0·0001), those whohad experienced pain within the previous 24 h (P=0·0001),and those with pulmonary oedema (P=0·04). This delaywas significantly shorter in patients with previous myocardialinfarction (P=0·02), those with ventricular fibrillation(P=0·0001), and those in shock (P0·0001). Thedelay between the two injections was significantly longer forolder patients (>65 years old; P=0·02), those withprevious myocardial infarction (P=0·03), and those inshock (P=0·003). CONCLUSIONS: Action undertaken to reduce delays between symptom onset andtreatment should focus on modifiable factors such as patientswho are likely to be late callers, i.e. women and those over65 years of age. |
