Delay from symptom onset to hospital presentation for patients with non-ST-segment elevation myocardial infarction
Henry H Ting1, Anita Y Chen, Matthew T Roe
1Division of Cardiovascular Diseases and Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. ting.henry@mayo.edu
Insights
Long delays from symptom onset to hospital presentation are common for non-ST-elevation myocardial infarction (NSTEMI) patients and have not changed. Early presentation is crucial for both STEMI and NSTEMI to improve outcomes.
Area of Science:
- Cardiology
- Public Health
Background:
- Delay time from symptom onset to hospital presentation is critical for myocardial infarction outcomes.
- While studied for STEMI, trends and factors influencing delay for non-STEMI are less understood.
Purpose of the Study:
- To investigate secular trends in delay times for non-STEMI patients.
- To identify factors associated with prolonged delay times.
- To examine the relationship between delay time and in-hospital mortality.
Main Methods:
- Analysis of 104,622 non-STEMI patients from the CRUSADE National Quality Improvement Initiative (2001-2006).
- Examination of secular trends in delay time.
- Multivariable analysis to identify factors associated with delay and its impact on mortality.
Main Results:
- Median delay time was 2.6 hours, showing no significant change from 2001-2006.
- Factors associated with longer delays included older age, female sex, nonwhite race, diabetes, and smoking.
- Patients presenting during night hours had shorter delay times compared to daytime presentations.
- Shorter delay times (0-3 hours) were associated with reduced in-hospital mortality compared to delays >6 hours.
Conclusions:
- Prolonged delay times remain a significant issue for non-STEMI patients and have not improved over time.
- Early hospital presentation is essential for both STEMI and non-STEMI, as patients cannot distinguish between the two.
- Addressing factors contributing to delays may improve patient outcomes.
Background:
Secular trends and factors associated with delay time from symptom onset to hospital presentation are known for patients with ST-segment elevation myocardial infarction (STEMI) but are less well-described for non-STEMI.
Methods:
We studied 104 622 patients with non-STEMI enrolled at 568 hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) National Quality Improvement Initiative from January 1, 2001, to December 31, 2006. We examined secular trends and factors associated with delay time and the association of delay time with in-hospital mortality.
Results:
Median delay time from symptom onset to hospital presentation was 2.6 hours (interquartile range, 1.3-6.0) and has been stable from 2001 to 2006 (P value for trend, .16). After multivariable adjustment, factors associated with longer delay time included older age, female sex, nonwhite race, diabetes, and current smoking. In addition, compared with those who presented during weekday daytime (>8 am to 4 pm), patients who presented during weekday and weekend nights (>12 am to 8 am) had a 24.7% and 24.3% shorter delay time, respectively (P < .001). After multivariable adjustment, the odds ratio of in-hospital mortality for patients with delay times of 0 to 1 hour or less, more than 1 to 2 hours, more than 2 to 3 hours, and more than 3 to 6 hours compared with the reference group (delay time >6 hours) were 1.19 (95% confidence interval [CI], 1.08-1.30), 0.91 (95% CI, 0.83-1.00), 0.77 (95% CI, 0.69-0.88), and 0.90 (95% CI, 0.81-1.00), respectively.
Conclusions:
Long delay times are common and have not changed over time for patients with non-STEMI. Because patients cannot differentiate whether symptoms are due to STEMI or non-STEMI, early presentation is desirable in both instances.
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