Korean J Intern Med.
2020 Jan;35(1):119-132. 10.3904/kjim.2019.123.
Pre-hospital delay and emergency medical services in acute myocardial infarction
- Lee SH1,2
- Kim HK3
- Jeong MH
1 - Lee JM2
- Gwon HC2
- Chae SC4
- Seong IW5
- Park JS6
- Chae JK7
- Hur SH8
- Cha KS9
- Kim HS10
- Seung KB11
- Rha SW12
- Ahn TH13
- Kim CJ14
- Hwang JY15
- Choi DJ16
- Yoon J17
- Joo SJ18
- Hwang KK19
- Kim DI20
- Oh SK21
- for the KAMIR Investigators
- Affiliations
-
- 1Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- 2Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
- 3Department of Cardiology, Chosun University Hospital, Gwangju, Korea
- 4Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- 5Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
- 6Division of Cardiology, Yeungnam University Medical Centre, Daegu, Korea
- 7Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
- 8Department of Cardiovascular Medicine, Keimyung University Dongsan Medical Centre, Daegu, Korea
- 9Department of Cardiology, Pusan National University Hospital, Busan, Korea
- 10Cardiovascular Centre, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- 11Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 12Cardiovascular Centre, Korea University Guro Hospital, Seoul, Korea
- 13Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
- 14Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- 15Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
- 16Cardiovascular Centre, Seoul National University Bundang Hospital, Seongnam, Korea
- 17Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- 18Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- 19Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- 20Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
- 21Division of Cardiology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
- KMID: 2501993
- DOI: http://doi.org/10.3904/kjim.2019.123
Abstract
- Background/Aims
Minimising total ischemic time (TIT) is important for improving clinical outcomes in patients with ST-segment elevation myocardial infarction who have undergone percutaneous coronary intervention (PCI). TIT has not shown a significant improvement due to persistent pre-hospital delay. This study aimed to investigate the risk factors associated with pre-hospital delay.
Methods
Individuals enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health between 2011 and 2015 were included in this study. The study population was analyzed according to the symptom-to-door time (STDT; within 60 or > 60 minutes), and according to the type of hospital visit (emergency medical services [EMS], non-PCI center, or PCI center).
Results
A total of 4,874 patients were included in the analysis, of whom 28.4% arrived at the hospital within 60 minutes of symptom-onset. Old age (> 65 years), female gender, and renewed ischemia were independent predictors of delayed STDT. Utilising EMS was the only factor shown to reduce STDT within 60 minutes, even when cardiogenic shock was evident. The overall frequency of EMS utilisation was low (21.7%). Female gender was associated with not utilising EMS, whereas cardiogenic shock, previous myocardial infarction, familial history of ischemic heart disease, and off-hour visits were associated with utilising EMS.
Conclusions
Factors associated with delayed STDT and not utilising EMS could be targets for preventive intervention to improve STDT and TIT.
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