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In order to determine whether prehospitalization characteristics of patients with chest pain are useful in predicting their subsequent course, we analyzed the precoronary care course in 211 consecutive patients admitted because of suspected myocardial infarction. On the basis of serial electrocardiograms and enzymes, 61 patients had a definite myocardial infarction on admission, 30 patients evolved criteria for an infarction during hospitallzation, 102 patients had cardiac pain without infarction, and 18 patients were judged to have noncardiac pain. The mean patient delay from onset of chest pain to arrival at the hospital was 456 ± 703 minutes (median 210 minutes). The decision to seek medical help consumed a mean 307 ± 575 minutes of this delay, whereas transportation to the hospital required only a mean of 17 ± 49 minutes. Known heart disease, known stable angina and progressive unstable angina tended to prolong the patient's decision to seek medical help. Of 140 patients who contacted a physician, 67 (48 per cent) were sent to the emergency room; whereas 71 had an additional mean 180 ± 436 minutes (median 38 minutes) of physician-advised delay consisting of office visits (59 patients), house call (five patients) and other attempted therapy (seven patients). The presence of prodromas or chest pain consistent with unstable angina was not significantly different in any patient group. We conclude that prodromas, although common, are not helpful in differentiating those with infarction from those without infarction among the patients hospitalized because of chest pain. Furthermore, the mean patient delay of over 6 hours and median delay of 3 12 hours indicates that this delay is the most immediate problem to be solved in order to decrease out of hospital mortality. |
