Abstract
The authors evaluated retrospectively prehospital and hospital treatment of patients with acute Q infarction of the myocardium (Q-IM) admitted within 12 hours after the development of complaints to the coronary unit during the period between October 1995 and October 1998 with special attention to hospital mortality. In the group of 361 patients with acute Q-IM elevation of ST or presence of bundle branch block the mortality was analyzed with regard to the method of treatment (primary PTCA, rescue PTCA and intravenous thrombolysis - IVT) and Killip's classification on admission.
The authors assessed the percentage of patients to whom during prehospital care acetylsalicylic acid (ASA) or a beta-blocker was administered. The hospital mortality of patients with acute Q-IM in primary PTCA was 7.9%, rescue PTCA 22.2%, intravenous thrombolysis 20.3% (p=0.05).
The time between the onset of complaints and the beginning of catheterization was in the group of rescue PTCA longer as compared with the group of primary PTCA (6.5 hours vs. 4.12 hours, p=0.05). EF under 40% was recorded in the group of rescue PTCA more frequently (40% vs. 26%, p=0.05).
During the prehospital period ASA was administered to 53.8%, a beta-blocker to 1.2% patients with Q-IM. Conclusion: primary PTCA can be considered optimal treatment in patients with acute Q-IM within 12 hours after the onset of complaints.
A longer period before the beginning of catheterization and poorer left ventricular function is according to the authors' opinion the cause of higher motility in the group of rescue PTCA as compared with primary PTCA in the investigated groups. ASA which lege artis should be administered to all patients with AIM during the prehospital stage was administered only to half the patients.
Only in rare instances to patients during the prehospital period a beta-blocker was given.