Delays incurred during acute myocardial infarction: a comparative study of rural and urban populations in Greece.

INTRODUCTION: Treatment delay during myocardial infarction may be due to a number of factors, such as age, sex, socioeconomic status and interpretation of symptoms. However, whether residence plays a role has not been fully investigated and, if known, could provide information that will help target specific populations. This study investigated whether urban and rural residents in Greece differ in the time required to seek and receive medical assistance during acute myocardial infarction, according to their characteristics and the determinants of their delay. METHODS: This was an observational study (with a structured interview) conducted in one academic and one regional hospital on the island of Crete, Greece, consisting of 348 patients with confirmed myocardial infarction. RESULTS: Patients from rural and urban areas did not differ in the decision time before seeking medical assistance (180 min vs 240 min, p=0.058). Those living in rural areas experienced a longer delay in reaching hospital once they sought assistance (50 min vs 20 min, p<0.0001). The total median delay time (4.25 hours for rural and 4.75 hours for urban patients, p=0.9) was positively affected by female sex and negatively affected by a patient's belief that symptoms were serious, and that they were heart-related. CONCLUSIONS: Strategies should be developed to reduce the treatment delay during myocardial infarction for residents of both urban and rural areas, especially for women. Patients interpreting symptoms as being serious and originating from the heart are important for a shorter delay. A better health system is needed in rural Greece in order to deal more effectively with medical emergencies such as myocardial infarction.

Acute coronary syndrome in an adult with anomalous origin of the left anterior descending coronary artery from the pulmonary trunk.

Anomalous origin of the left anterior descending coronary artery is a very rare coronary vascular anomaly, especially in adults. We describe the case of a 45-year-old woman who presented with an acute coronary syndrome. Coronary angiography revealed an anomalous origin of the left anterior descending coronary artery from the main pulmonary trunk, with collateral filling from both the left circumflex and the right coronary artery. Treatment of choice of this coronary anomaly is usually surgical repair, while intense antithrombotic therapy should be considered, especially if the anomalous vessel is ectatic.