Journal of Korean Academy of Nursing (대한간호학회지)

Korean Society of Nursing Science (한국간호과학회)
권호 표지

Pre- and In-Hospital Delay in Treatment and in-Hospital Mortality after Acute Myocardial Infarction

  • An, Kyuneh (College of Nursing, Ewha Woman′s University) ;
  • Koh, Bongyeun (Department of Emergency Medical Technology, Dongnam Health College)
  • Published : 2003.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose. 1) To identify the time taken from symptom onset to the arrival at the hospital (pre-hospital delay time) and time taken from the arrival at the hospital to the initiation of the major treatment (in-hospital delay time) 2) to examine whether rapid treatment results in lower mortality. 3) to examine whether the pre- and in-hospital delay time can independently predict in-hospital mortality. Methods. A retrospective study with 586 consecutive AMI patients was conducted. Results. Pre-hospital delay time was 5.25 (SD=10.36), and in-hospital delay time was 1.10 (SD=1.00) hours for the thrombolytic therapy and 50.24 (SD=121.18) hours for the percutaneous transluminal coronary angio-plasty (PTCA). In-hospital mortality was the highest when the patients were treated between 4 to 48 hours after symptom onset using PTCA (p=.02), and when treated between 30 minutes and one hour after hospital arrival using thrombolytics (p=.01). Using a hierarchical logistic regression model, the pre- and in-hospital delay times did not predict the in-hospital mortality. Conclusion. Pre- and in-hospital delay times need to be decreased to meet the desirable therapeutic time window. Thrombolytics should be given within 30 minutes after arrival at the hospital, and PTCA should be initiated within 4 hours after symptom onset to minimize in-hospital mortality of AMI patients.

Keywords

References

  1. American Heart Association (1999). 1998 Heart and Stroke: statistical update. Dallas, Tex
  2. American Heart Association (2003). http://www.americanheart.org
  3. An, K. (2001). Pre-hospital delay in treatment after acute myocardial infarction. I Korean Acad Nurs, 31(7), 1141-1150
  4. Anderson, J. L., Karagounis, L. A., & Muhlestein, J. B. (1996). Explaining Discrepant Mortality Results Between Primary Percutaneous Transluminal Coronary Angioplasty and Thrombolysis for Acute Myocardial Infarction. Am J Cardiol, 78(8).934-939
  5. Becker, R. C.,Burns, M., Gore, J. M., Spencer, F. A., Ball, S. P., French, W., Lambrew, c., Bowlby, L., Hilbe, J., Rogers, W. J., & The National Registry of Myocardial Infarction(NRMI-2) Participants. (1998). Early assessment and in-hospital management of patients with acute myocardial infarction at increased risk for adverse outcome; A nationwide perspective of current clinical practice. Am Heart J,135(5(1)), 786-796
  6. Berger, A. K, Radford, M. J., & Krumholz, H. M. (2000). Factors associated with delay in reperfusion therapy in elderly patients with acute myocardial infarction; Anaysis of the Cooperative Cardiovascular Project. Am Heart J, 139(6), 985-992
  7. Berger, A. K, Schulman, K A., Gersh, B. J., Pirzada, S., Breall, J. A., Johnson, A. E., & Every, N. R. (1999). Primary Coronary Angioplasty vs Thrombolysis for the Management of Acute Myocardial Infarction in Elderly Patients. JAMA, 282(4), 341-348
  8. Berger, P. B., Ellis, S. G., Holmes, D. R. Jr., Granger, C. B., Criger, D. A., Betriu, A., Topol, E. J., & Calif-RM (1999). Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction: results from the global use of strategies to open occluded arteries in Acute Coronary Syndromes (GUSTO-IIb) trial. Circulation, 100(1), 14-20
  9. Berger, P. B., Holmes, D. R., Califf, R. M., & Criger, D. A. (1997). Hospital Delay in Achieving Reperfusion with Direct PTCA in GUSTO-IIb: Relationship to 30-day Mortality. Circulation, 96(8S),531-1
  10. Blohm, M. B., Hartford, M., Karlsson, T., & Herlitz, J. (1998). Factors associated with pre-hospital and in-hospital delay time in acute myocardial infarction: a 6-year experience. J intern Med, 243(3), 243-250
  11. Boersma, E., Maas, Ac., Deckers, J.W., & Simoons, M.L. (1996). Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet, 348, 673-682
  12. Cannon, C. P., & Goldhaber, S. Z. (1995). The Importance of Rapidly Treating Patients with Acute Myocardial Infarction. Chest, 107(3),598-600
  13. Cannon, C. P., Gibson, C. M., Lambrew, C. T., Shoultz, D. A., Levy, D., French, W. J., Gore, J. M., Weaver, W. D., Rogers, W. J., Gore, J. M., Weaver, W. D., Rogers, W. J., & Tiefenbrunn, A. J. (2000). Relationship of Symptom-Onset- ToBalloon Time and Door-to-Balloon Time With Mortality in Patients Undergoing Angioplasty for Acute Myocardial Infarction. JAMA, 283(22), 2941-2947
  14. Cannon, P. C., Johnson, E. B., Cermignani, M., Scirica, B. M., Sagarin, M. J., & Walls, R. M. (1999). Clinical investigations: emergency department thrombolysis critical pathway reduces Door-to-Drug times in acute Myocardial infarction. Clin Cardiol, 22, 17-20
  15. Castella, X., Gilabert, J., Tomer, F., & Torres, C. (1991). Mortality prediction models in intensive care: Acute Physiology and Chronic Health Evaluation II and Mortality Prediction Model compared. Critical Care Med, 19(2), 191-197
  16. Chareonthaitawee, P., Christian, T. F., O'Connor, M. K, Berger, P. B., Grines, C. L., & Gibbons, R. J. (1997). Noninvasive prediction of residual blood flow within the risk area during acute myocardial infarction: A multicenter validation study of patients undergoing direct coronary angioplasty. Am Heart J, 134(4), 639-646
  17. Gilbler, W. B., Armstrong, P. W., Ohman, E. M., Weaver, W. D., Stebbins, A. L., Gore, J. M., Newby, L. K, Califf, R. M., & Topol, E. J. (2002). Persistence of delays in presentation and treatment for patients with acute myocardial infarction: the GUSTO-I and GUSTO-III experience. Ann Emerg Med, 39(2), 124-130
  18. Goldberg, R. J., Gurwitz, J., Yarzebski, J., Landon, J., Gore, J. M., Alpert, J. S., Dalen, P. M., & Dalen, J. E.(1992). Patient delay and receipt of thrombolytic therapy among patients with acute myocardial infarction from a community-wide perspective. Am-j-Cardiol., 70(4), 421-5
  19. Gonzalez, E. R., Jones, L. A., Ornato, J. P., Bleecker, G. C., and Strauss, M. J. (1992). Hospital delays and problems with thrombolytic administration in patients receiving thrombolytic therapy: a multicenter prospective assessment. Virginia Thrombolytic Study Group [see comments]. Ann-Emerg-Med., 21(10), 1215-21
  20. Gruppo Italiano per studio della streptochinasinell Infarcto miacardico (GISSI) (1986). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction, Lancet, 397
  21. Herlitz, J., Blohm, M., Hartford, M., Karlson, B. W., Luepker, R., Holmberg, S., Risenfors, M., & Wennerblom, B. (1992). Follow-up of a 1-year media campaign on delay times and ambulance use in suspected acute myocardial infarction. Eur-Heart-J., 13(2), 171-7
  22. Herlitz, U. Hartfort, M., &Blohm, M.(1989). Effect of a media campaign on delay times and ambulance use in suspected acute myocardial infarction. Am J Cardiol, 64, 90
  23. Hwang, S. O. (1995). Reasons for not receiving reperfusion therapy in acute myocardial infarction. Korean J Internal Med, 48(6), 783-789
  24. Jung, J. O., Kim, Y. C., Sung, B. Y., Kim, J. K., lung, J. Y., Ru, J. G., Sung, I. H., & Jeon, E. S. (1997). Morphological characteristics of intimal hyperplasia in stented coronary arteries assessed with intravascular ultrasound. Korean Circulation, 27(8), 842-850
  25. Kelion, A. D., Banning, A. P., Shahi, M., & Bell, J. A. (1998). The effect of reduction of door-to-needle times on the administration of thrombolytic therapy for acute myocardial infarction. Postgrad-Med-J., 74(875), 533-536
  26. Kereiakes, D. J., Gibler, W. B., Martin, L. H., Pieper, K. S., & Anderson, L. C., (1992). Relative importance of emergency medical system transport and the prehospital electrocardiogram on reducing hospital time delay to therapy for acute myocardial infarction: a preliminary report from the Cincinnati Heart Project. Am-Heart-J., 123(4 Pt 1), 835-840
  27. Kim, C. J., and Kim, G. Y. (1999). Treatment-seeking behavior among those with signs and symptoms of acute myocardial infarction. Korean J Nurs, 29(3), 605-613
  28. Korea National Statistical Office (1999). http://www.nso.ac.kr
  29. Korea Statistical Office (2003). Retrieved from the site on 2003/9/01. http://www.nso.go.kr
  30. Leizorovicz, A., Boissel, J. P., & Robert, F. (1992). Coronary reperfusion rates in acute myocardial infarction patients after thrombolytic treatment with anistreplase: correlation with the delay from onset of symptoms to treatment: a review of 424 case records of patients admitted to coronary reperfusion studies with anistreplase. J-Cardiouasc-Pharmacol., 19(1),34-39
  31. Mitic, W. R.,& Perkins, J. (1984). The effect of a media campaign of heart attack delay and decision times. Can J Public Health, 75,415
  32. National Institute of Health (1998). Morbidity and Mortality: 1996 Chart book on Cardiovascular, Lung and Blood Disease
  33. Park, O.J., Kim, C. J., Lee, H. Y.,& Lee, H. O. (2000). A survey on the delay time before seeking treatment and clinical symptoms in patients with acute myocardial infarction. Korean J Acod Nurs, 30(3), 659-669
  34. Schwarz, B, Schoberberger, R., Rieder, A., & Kunze, M.(1994). Factors delaying treatment of acute myocardial infarction. Eur Heart J, 15(12), 1595-1598
  35. Song, M. K. (1997). The prehospital delay time in patients with acute myocardial infarction. Unpublished thesis, The Catholic University of Korea, Seoul
  36. Yoo, B. S., Yoon, J. H., Park, K. S., Ahn, S. C.,Yoh, K. K., Cho, Y. K., Song, K. S., Lee, B. S., & Hwang, S. O. (1995). Reasons for not receiving reperfusion therapy in acute myocardial infarction. Korean Internal Med, 48(6), 783-789