The Comparison of Reasons for not Receiving Reperfusion Therapy on Acute Myocardial Infarction for the Recent 10 Years

ABSTRACT

BACKGROUND AND OBJECTIVES: This study was performed to evaluate the changing aspects of the reasons why patients with an acute myocardial infarction were not given the adequate reperfusion therapy over the last 10 years. SUBJECTS AND METHODS: All patients were divided into a reperfusion group (phase I=55, phase II=289) who received reperfusion therapy such as a thrombolytic trial or direct PCI, and a conservative group who had not received reperfusion therapy (phase I=83, phase II=81). We analyzed the clinical characteristics and the various time delays from chest pain onset, the first hospital arrival time, the transfer time, the ER arrival time, and the door to reperfusion time in 138 patients with acute myocardial infarction admitted to Wonju Christian Hospital from Jan. 1991 to Oct. 1993 and 370 patients from Jan. 1997 to Jun. 2002. RESULTS: 55 cases (39.9%) received an adequate reperfusion therapy during phase I and 289 cases (78.1%) received an adequate reperfusion therapy on phase II. 213 cases (78.1%) received direct PTCA on phase II and 12 cases on phase I. The patient time delay was 305.0+/-346.8 min and 253.7+/-233.4 min, the first hospital time delay, 237.2+/-320.7 min and 183.0+/-243.6 min in phase I and phase II. Only 4.8% of patients was were transferred from the first hospital after reperfusion therapy in phase I, but 43.1% of patients were transferred in phase II. The Patient time delay was the most common reason for not receiving reperfusion therapy in phase I, and II, and the time delay and lack of adequate reperfusion therapy at the first hospital despite the early arrival were the second most common reason. Other reasons included a contraindication to lytic therapy, a subsidence of pain or a ST segment elevation, no initial change in the ST segment on EKG and a delay in therapy. CONCLUSION: The most common reason of not receiving reperfusion therapy was patient delay and the time delay at the first hospital. In addition, reperfusion therapy in the first hospital has increased over the last 10 years. To maximize the effectiveness of reperfusion therapy, it is important to shorten the hospital arrival time delay and to use reperfusion therapy at the first hospital.