[Prehospital delay-not just a question of patient knowledge]

Patients with acute myocardial infarction reaching the hospital within the first hour after symptom onset preserve their chances for an optimal treatment. But only about one fifth of them actually reach the hospital within this "golden hour". Information of the public to reduce time from symptom onset to medical service call have shown success only during the time the continuous publicity was maintained. Soon after the end of such activities the prehospital delay again reached the initial duration. Because of restricted resources, prehospital thrombolysis as another means of reducing time to treatment is as yet only used for a very small proportion of patients. Reduction of door-to-balloon and -treatment time seems to have reached its limit in recent years. In patients with delayed hospital admission, the use of PTCA interventions seems to result in better outcome data compared to thrombolysis.