Prehospital sudden death from acute myocardial infarction in Tomsk (1984 and 2018): what has changed for 34 years

Aim. To compare the circumstances of the prehospital deaths among patients with acute myocardial infarction (AMI) in Tomsk in 1984 and 2018.Methods. Population-level data were collected from the WHO project “Acute Myocardial Infarction Registry”. In 1984, 739 cases of AMI were recorded, in 2018 - 924 ones. 262 (35.5%) and 359 (38.9%) deaths occurred in the acute phase, respectively. Of them, 158 (60.3%) and 148 (41.2%) patients died in the prehospital setting. 66 (41.8%) and 46 (31.1%) cases of deaths were selected for further analysis.Results. In 2018, the number of patients who did not receive timely medical care decreased from 74.2% to 52.2%, compared to 1984 (p <0.05). The number of cases when patients failed to call the ambulance due to a rapid loss of consciousness (cardiac arrest) or managed to call, but died before the ambulance arrived, was similar. The number of death among patients who received emergency medical services (EMS) increased from 25.8% to 47.9% (p <0.05).Conclusion. Prehospital mortality from AMI in Tomsk has improved over thirty years, but not drastically. Despite the number of patients who died before the first medical contact has decreased, they still make up about half of all cases. Every 4th-5th patient fails to contact EMS. In terms of reducing prehospital mortality, measures focused on the regular clinical examination of patients with cardiovascular diseases seem to be more promising for effective secondary prevention of coronary artery disease and AMI.