Out of Hospital Management of Acute Myocardial Infarction

Abstract

In 1971 we first showed that among those seen early after the onset of acute myocardial infarction and managed out of hospital by a mobile coronary care unit the incidence of cardiogenic shock and hospital mortality was significantly lower in comparison with those seen late (Table 1) [1]. The data concerning these patients managed in 1969 showed a significantly lower incidence of shock and a lower hospital mortality among those seen within the first 3 hours compared with those seen after 3 hours although all were managed in the same way (Table 1). The age range was 30–86 years. There was no significant difference in age, sex or number of patients with previous infarction among the groups indicated. One hundred and sixteen of the 123 patients seen within the first hour were aged 70 or less. The incidence of shock among these patients was 3.5% and the hospital mortality 9%. One hundred and eleven of the 123 patients seen within the first hour survived to leave hospital and 99 (89%) of these patients were alive at the one year follow-up. This was the first time that an overall reduction in hospital mortality and incidence of cardiogenic shock had been shown by the early management of patients with acute myocardial infarction. However, this was in an era when thrombolytic agents were not administered to patients following acute myocardial infarction.