Factors related to prehospital time delay in acute ST-segment elevation myocardial infarction
Yong Hwan Park1, Gu Hyun Kang, Bong Gun Song
1Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Insights
Prehospital delay in ST-segment elevation myocardial infarction (STEMI) patients is linked to lower education, nighttime onset, and private transport. This delay increases in-hospital mortality risk, highlighting areas for intervention.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Door-to-balloon time in ST-segment elevation myocardial infarction (STEMI) has improved, but prehospital delay remains a significant challenge.
- Factors contributing to prehospital delay in Korea are not well-defined, impacting timely treatment for acute myocardial infarction.
Purpose of the Study:
- To identify sociodemographic and clinical factors associated with prehospital delay in STEMI patients in Korea.
- To investigate the impact of prehospital delay on inhospital mortality.
Main Methods:
- Retrospective analysis of 423 STEMI patients.
- Patients categorized into short (≤180 min) and long (>180 min) prehospital delay groups based on symptom onset-to-door time.
- Multivariate analysis to identify independent predictors of prehospital delay.
Main Results:
- Mean symptom onset-to-door time was 255 minutes; long delay was associated with significantly higher inhospital mortality (6.9% vs 2.8%).
- Factors significantly associated with long prehospital delay included low educational level, nighttime symptom onset, triage via another hospital, and private transport.
- Multivariate analysis confirmed low education, nighttime onset, triage via another hospital, and private transport as significant predictors of prehospital delay.
Conclusions:
- Prehospital delay in STEMI is influenced by socioeconomic factors (low education), time of onset (nighttime), healthcare access (triage via other hospital), and transport method (private transport).
- Addressing these factors is crucial for reducing prehospital delay and improving outcomes for STEMI patients.
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: ≤ 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.
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