What is the clinical evidence from this study?

Study design: Observational. Population: Acute myocardial infarction (n=388). Intervention: Emergency PTCA, PTCR, or admission to CCU vs. Other treatments or admission to institutions without CCU. Primary outcome: Hospital case-fatality rates.

What does this research mean for the field?

Emergency percutaneous transluminal coronary angioplasty (PTCA), percutaneous transluminal coronary recanalization (PTCR), and admission to coronary care units (CCU) significantly decrease the fatality risk in acute myocardial infarction patients, highlighting the critical need for appropriate ambulance triage. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 1999Open Access

Analysis of the Treatment of Acute Myocardial Infarction Using Ambulance Records in Japanese Cities

NFNobusada FunabashiTokyo Dental College Ichikawa General Hospital MSMasayuki ShimaMukogawa Women's University MAMotoaki AdachiShofu (Japan)

Key Result

Emergency PTCA, PTCR, and admission to CCU decreased fatality risk in AMI patients, highlighting the need for proper transfer as 40% of patients were sent to institutions without CCU.

Study Design

Type

Observational (n=388)

Multicenter

Yes

Structured PICO

Does emergency PTCA/PTCR and admission to CCU-equipped institutions reduce hospital case-fatality rates in patients with acute myocardial infarction?

Population

388 patients admitted within 2 weeks after onset from a total of 31,191 patients transported by ambulance in 1992 in Chiba City and Ichihara City, Japan. 168 patients fulfilled the criteria of definite acute myocardial infarction (AMI) and were admitted alive.

Intervention

Emergency percutaneous transluminal coronary angioplasty (PTCA) or recanalization (PTCR), and admission to coronary care units (CCU) or institutions equipped with coronary angiography.

Comparator

Admission to institutions without CCU or coronary angiography, and not receiving emergency PTCA or PTCR.

Outcome

Hospital case-fatality rateshard clinical

Admission to CCU-equipped facilities and the use of emergency PTCA/PTCR significantly reduces hospital mortality in patients with acute myocardial infarction.

Abstract

By means of ambulance records, the current state of medical services for the treatment of acute myocardial infarction (AMI) was investigated in Chiba City and Ichihara City, Japan. From all patients transported by ambulance personnel in 1992 (n=31,191), 388 patients who were admitted within 2 weeks after the onset were studied. Types of admitting institution, diagnoses, medical treatments and prognoses were investigated. According to medical records, 168 patients fulfilled the criteria of definite AMI and were admitted alive. Percutaneous transluminal coronary angioplasty (PTCA) and recanalization (PTCR) were performed on 54 and 6 patients, respectively. The hospital case-fatality rates were lower in the patients who underwent emergency PTCA or PTCR than in the others. Emergency PTCA or PTCR, and admission to coronary care units (CCU) or institutions equipped with coronary angiography, decreased the fatality risk, even after considering age, sex, and disease severity. These results show the importance of the selection of institutions for AMI patients. Because 40% of definite AMI patients were sent to institutions without CCU, it is essential that enough CCU are available through an improvement in cooperation between the various types of institutions, and in the proper transfer of AMI patients to CCU

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