[In Time? Time interval between first symptoms to hospital admission of patients with acute coronary syndromes].

Objective: To assess the pre-hospital delay, i.e. the period which elapses between the onset of pain on the chest and admission to hospital in patients hospitalized on account of acute coronary syndrome. To analyze factors which influence this time interval and obtain thus data for a strategy leading to reduction of the pre-hospital delay.

Method: Collection of data by means of a questionnaire focused on the time of onset of pain on the chest, time of contact with the health service, time of admission to hospital, type of transport of the patient to hospital, socioeconomic data, manifestations of ischaemic heart disease during the premorbid period and health care provided. Statistical evaluation by the non-paired Mann-Whitney test.

Results: Data were assembled from 126 patients admitted to hospital on account of acute coronary syndrome. The median of pre-hospital delay was 5 hours 40 mins., the median of the patient's hesitation 3 hours 44 mins., the median of the transport period was 59 mins. The pre-hospital delay is significantly reduced by transport by the rapid emergency service (p < 0.0001), dispensary care of a cardiologist (p < 0.02) and a previous hospitalization on account of acute myocardial infarction or unstable angina pectoris (p < 0.04). Pre-hospital delay is significantly prolonged in old age pensioners (p < 0.05). On the borderline of signficance is the reduction of pre-hospital delay in patients younger than 80 years (p < 0.06) and patients with higher than elementary education (p = 0.102).

Conclusion: Prehospital delay in the investigated group is almost three times longer as compared with data from abroad. A most significant part in this delay is played by the long hesitation of patients and transport of the patient to the health institution by other means than the rapid emergency service. In order to provide effective treatment to a larger number of patients with acute coronary syndrome within the shortest time interval it is necessary to inform the population at large on the importance of sudden pain on the chest and the necessity of the quickest possible contact with the rapid emergency service on phone 155. Only then can we expect further improvements of the prognosis of these patients.