[Emergency care of patients with myocardial infarction: from the onset of symptoms until opening the vessel].

Abstract

Introduction: The effectiveness of the treatment of patients with myocardial infarction and their life prospects are significantly influenced by the total ischemic time, which is calculated from the onset of the complaint to the opening of the vessel. Objective: In our study, we analyzed the length of the components of the total ischemic time and compared it with the results of the study five years earlier. Method: We analyzed the data of 8705 patients treated for acute myocardial infarction registered between 01. 07. 2022 and 30. 06. 2023 (4334 [49.8%] STEMI, 3428 [39.4%] women), for whom all data were available for the calculation of each time interval. In the case of times, the median values and notable quartiles (lower quartile, Q1 and upper quartile, Q3) were given, similarly to our previous study. The diagnosis was established during hospitalization, based on the valid criteria. We examined patient delay, i.e., the time elapsing from the complaint to the notification of the ambulance service, from the notification to the arrival at the scene, and from the scene to the arrival at the hospital. During hospital care, we examined the time between the admission of the patient and the opening of the vessel (door-to-needle time). The data were also provided in national and county breakdowns. Results: The median patient delay for STEMI patients nationwide was 140 minutes (Q1: 51; Q3: 458). The median ambulance arrival time was 13.2 minutes (Q1: 8.0; Q3: 21.1), the median on-site care time was 25.5 minutes (Q1: 17.6; Q3: 34.9), and the median on-site to hospital time was 31.0 minutes (Q1: 19.5; Q3: 43.7). The range of arrival time per county was 8.8–17.9 minutes. The median door-to-needle time for STEMI patients nationwide was 51.5 minutes (Q1: 28.7; Q3: 121.7). In the NSTEMI group, the median patient delay was 373 minutes (Q1: 106; Q3: 1184), and the time to arrival at the scene was 14.2 minutes (Q1: 8.5; Q3: 24.8). In the case of STEMI, the patient delay increased by almost 40 minutes compared to the previous period (101 vs. 140 minutes), and the median time to arrival of the ambulance at the scene (13.0 vs. 13.2 minutes) did not change significantly. The door-to-needle time in the present study was almost by 15 minutes longer than before (37.0 vs. 51.5 minutes). In the STEMI group, the vessel was opened within 2 hours in 4.1% of the patients and within 4 hours in 38.3% of the patients. Conclusion: The patient’s delay is the determining factor in terms of total ischemic time, therefore, in a significant proportion of treatments, revascularization did not take place at the optimal time. Orv Hetil. 2025; 166(25): 963–969.