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Heart 1998;80:114-120 ( August )
Correspondence to: Dr R M Norris, Cardiac Department, Royal Sussex County Hospital, Brighton, East Sussex BN2 5BE, UK.
Accepted for publication 12 January 1998
Objective
To examine
the relation between time from onset of symptoms and coming under
ambulance and hospital care on fatality in patients with evolving acute
myocardial infarction, and on the proportions who survive because of
resuscitation and thrombolytic treatment.
DesignProspective
community and hospital study over two years. Delay was measured from
the onset of symptoms to arrival at hospital, and from the onset to
coming under care from ambulance personnel.
SettingFour
general hospitals serving three United Kingdom health districts.
Patients2213 patients
under 75 years of age, 111 of whom had been successfully resuscitated
from out of hospital cardiac arrest.
InterventionsResuscitation
from cardiac arrest; thrombolytic treatment.
Main outcome
measures30 day fatality and lives saved by the
two forms of treatment.
ResultsTimes from
symptom onset to coming under hospital care and to starting
thrombolytic treatment (given to 53% of patients) were 
1 hour in
15% and 2% of patients respectively, 2 hours in 54% and 25%,
and 4 hours in 67% and 55%. Overall, 30 day fatality was
138/1000 patients treated; 64/1000 (95% confidence interval 54 to 74)
survived because of treatment, and 80% of this salvage was
attributable to resuscitation. Delay was an important factor: 107/1000
(60 to 144) lives were saved for those coming under care within 1 hour
compared with 21/1000 (5 to 37) for those who delayed for more than 12 hours. Further analysis including the 111 patients with out of hospital
arrest showed that 34% of those coming to hospital by ambulance came
under ambulance care within 1 hour; for this subset, 30 day fatality
was 173/1000, and 136 (109 to 163) lives were saved by treatment.
ConclusionsResults of
treatment are strongly related to delay in coming under care. Reduction
in delay can reduce mortality from acute myocardial infarction.
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