Time is heart muscle, time is life

  Acute myocardial infarction episodes often occur without warning, leaving the patient overwhelmed and unsure of what to do. Typical attack symptoms include persistent chest tightness, chest pain, pressure or choking sensation, with radiating pain in the left shoulder and back, and sweating. The pathological basis is the sudden rupture of atheromatous plaque deposited in the inner wall of the coronary arteries of the heart, which leads to thrombosis and complete blockage of the coronary arteries, interrupting the blood and oxygen supply to the myocardium, eventually leading to myocardial necrosis, destroying the function of the heart and possibly triggering malignant arrhythmias (such as ventricular fibrillation) at any time, leading to sudden death. About 40% of patients may die before they are even admitted to the hospital.  The best accepted treatment is reperfusion therapy. This includes medication (thrombolysis) and emergency coronary intervention to open the closed vessel. It has been clinically proven that stenting is significantly better than drug therapy, with an opening rate of over 95% and a mortality rate of less than 10%. However, the procedure needs to be performed in a timely manner to be effective.  Normally, the heart muscle dies after the blood supply is cut off. If the blood vessels cannot be reperfused within 6 hours, the chances of restoring life to the heart muscle are very slim. On the contrary, if the blood vessels can be reopened within 1 hour, the degree of myocardial damage can be minimized, and even 35% of patients will have no myocardial cell necrosis at all afterwards. Medical science generally considers 3 hours after a heart attack as the “golden hour”. If the patient can be saved in time, the incidence of adverse events such as death and heart failure can be reduced to a minimum. Time is heart muscle, time is life.  According to a survey in Beijing, only about 50% of heart attack patients are admitted to hospitals within 3 hours, which means that almost half of them are treated after the “golden hour”. This may be related to the lack of knowledge about heart attack and the delay in seeking medical treatment because people do not realize the seriousness of the situation. Data also shows that the cardiac mortality rate is only 5.8% for patients admitted to the hospital in the first 3 hours after receiving surgery. However, once the delay in getting to the hospital is more than 6 hours, the mortality rate increases dramatically to 18.2%, which is 20% higher. For every hour of delay, the mortality rate increases by 10% in relative terms. The international medical community has adopted the time from infarction patient visit to balloon dilation (door-to-balloon, or D2B) as an indicator of hospital operating procedures. It is generally required that the balloon be allowed to dilate the infarct-related artery within 90 minutes of the patient’s admission in order to meet the standard. The 2008 D2B time for the Beijing hospital survey was 138 minutes, and only 19% of patients were able to receive treatment within 90 minutes. This is related to the level of treatment received by the patient himself, his financial situation, and the level of the hospital. We need to reinforce the public’s alertness to the symptoms of heart attack and encourage the summoning of ambulances to hospitals for medical attention at the onset of the condition.