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[Delayed thrombolytic administration in myocardial infarction;]

F J Ochoa Gómez1, J M Carpintero Escudero, E Ramalle-Gómara

  • 1Unidad de Cuidados Intensivos, Complejo Hospitalario San Millán-San Pedro, INSALUD, Logroño.

Medicina Clinica
|April 5, 1997
PubMed
Summary

Consulting a doctor before hospital arrival delays critical care unit admission for acute myocardial infarction (AMI) patients. This delay also reduces their chances of receiving timely thrombolytic therapy.

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Public Health

Background:

  • Acute myocardial infarction (AMI) management requires timely intervention.
  • Pre-hospital care pathways can influence treatment timeliness.
  • Understanding the impact of extra-hospitalary physician consultations on AMI patient outcomes is crucial.

Purpose of the Study:

  • To determine if consulting an extra-hospitalary physician before hospital arrival delays critical care unit (CCU) admission for AMI patients.
  • To assess if this pre-hospital consultation reduces the likelihood of receiving early thrombolytic therapy.

Main Methods:

  • A descriptive study analyzed 118 patients diagnosed with AMI in 1995.
  • Data collected included demographics, previous AMI history, extra-hospitalary physician consultation, and time to CCU admission.

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  • Statistical analyses included proportion comparisons, t-tests, Mann-Whitney U-test, and multiple logistic regression.

    • Main Results:

    • Patients consulting an extra-hospitalary physician experienced a 100-minute delay in hospital arrival and a 124-minute delay in CCU admission.
    • These patients had a 3.3 times higher risk of CCU admission after 3 hours from symptom onset (OR: 3.3, 95% CI: 1.2-9.2).
    • Delay to hospital arrival was the primary reason for exclusion from early thrombolytic treatment.

    Conclusions:

    • Consultation with an extra-hospitalary physician before hospital arrival is associated with delayed CCU admission for AMI patients.
    • These patients have a significantly lower probability of receiving early thrombolytic therapy within the critical first 3 hours.