[Delayed thrombolytic administration in myocardial infarction;]

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.
• 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.