[Evaluation of the delays in treatment of myocardial infarction. Results of a survey in Alsace].

In order to assess the conditions of access to emergency care of acute myocardial infarction in Alsace, the authors carried out a survey in all hospitals and medical clinics in the region. All subjects admitted for acute myocardial infarction in the region between 3rd December 1995 and 3rd April 1996 were included. The study population comprised 405 persons. The onset of symptoms usually occurred at the patient's home (85% of cases). The first call was made to the general practitioner in 65% of cases. The emergency ambulance transported 40% of patients. The median time to hospital admission was 5 h 15 (average 21 h); the delay was greater in patients over 65 years of age (6 h 42 versus 3 h 51, p < 0.01). This mainly resulted from a delay in calling the doctor by the patients. Thirty nine per cent of patients underwent a myocardial revascularisation procedure (thrombolysis: 27%, direct coronary angioplasty: 12%). Therefore, ten years after a similar study, this survey shows that the delay to hospital admission has not improved and is still too long for effective emergency therapy to be given. In a region where ischaemic heart disease accounts for 10% of all deaths, a multidisciplinary approach is required to elaborate a regional policy for optimising the management of acute myocardial infarction.