Current status of prehospital care of patients with acute myocardial infarction in Tokyo: Analysis of 3-year experience with coronary care unit network.

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Abstract
To clarify the current status of prehospital care of patients with acute myocardial infarction (AMI) in the Tokyo metropolitan area, the availability of the coronary care unit (CCU) network during the past 3 years (January 1982 through December 1984) was analyzed, examining: 1) final diagnosis, 2) circumstances at the onset of AMI<3) course of transportation to CCU, 4) time elapsed before admission, 5) severity of AMI, and 6) prognosis of patients. Of 6, 939 patients admitted to CCU by means of the CCU network, 2, 408 patients (34.7%) had AMI. The patient's decision time was, on the average, 12 hr 3 min, longer when the course of transportation to CCU was more complicated. The fatality for AMI was 17.2%. Causes of death were pump failure in 52.8%, arrhythmias in 62.8% and mechanical failure such as cardiac repture in 8.5%. Patients with complicated AMI were admitted earlier and had a higher fatality than those without complications. Thus, 1) Community oriented programs are required to more fully inform the population at risk of AMI to shorten the patient's decision time, and 2) more effective means to treat patients with pump failure and to prevent the development of pump failure nead to be established.