J Korean Med Sci.  2012 Aug;27(8):864-869. 10.3346/jkms.2012.27.8.864.

Factors Related to Prehospital Time Delay in Acute ST-Segment Elevation Myocardial Infarction

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
  • 2Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
  • 3Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea. ydkim@mail.donga.ac.kr

Abstract

Despite recent successful efforts to shorten the door-to-balloon time in patients with acute ST-segment elevation myocardial infarction (STEMI), prehospital delay remains unaffected. Nonetheless, the factors associated with prehospital delay have not been clearly identified in Korea. We retrospectively evaluated 423 patients with STEMI. The mean symptom onset-to-door time was 255 +/- 285 (median: 150) min. The patients were analyzed in two groups according to symptom onset-to-door time (short delay group: < or = 180 min vs long delay group: > 180 min). Inhospital mortality was significantly higher in long delay group (6.9% vs 2.8%; P = 0.048). Among sociodemographic and clinical variables, diabetes, low educational level, triage via other hospital, use of private transport and night time onset were more prevalent in long delay group (21% vs 30%; P = 0.038, 47% vs 59%; P = 0.013, 72% vs 82%; P = 0.027, 25% vs 41%; P < 0.001 and 33% vs 48%; P = 0.002, respectively). In multivariate analysis, low educational level (1.66 [1.08-2.56]; P = 0.021), symptom onset during night time (1.97 [1.27-3.04]; P = 0.002), triage via other hospital (1.83 [1.58-5.10]; P = 0.001) and private transport were significantly associated with prehospital delay (3.02 [1.81-5.06]; P < 0.001). In conclusion, prehospital delay is more frequent in patients with low educational level, symptom onset during night time, triage via other hospitals, and private transport, and is associated with higher inhospital mortality.

Keyword

Myocardial Infarction; Prehospital Delay; Mortality

MeSH Terms

Acute Disease
Aged
Demography
Electrocardiography
Emergency Service, Hospital
Female
Hospital Mortality
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Myocardial Infarction/*mortality/physiopathology
Retrospective Studies
Socioeconomic Factors
Time Factors
Triage

Figure

  • Fig. 1 Distribution of patients arriving with different symptom onset-to-door time.

  • Fig. 2 In hospital, 30-day, 6-month mortality based on symptom onset-to-door time.

  • Fig. 3 Kaplan-Meier curve of study subgroups based on symptom onset-to-door time.


Cited by  6 articles

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Community-Based Pre-Hospital Electrocardiogram Transmission Program for Reducing Systemic Time Delay in Acute ST-Segment Elevation Myocardial Infarction
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Gender Differences in Factors Related to Prehospital Delay in Patients with ST-Segment Elevation Myocardial Infarction
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Yonsei Med J. 2017;58(4):710-719.    doi: 10.3349/ymj.2017.58.4.710.

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J Lipid Atheroscler. 2016;5(1):21-26.    doi: 10.12997/jla.2016.5.1.21.

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