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Published on: May 28, 2019
Independent Predictors of Late Presentation in Patients with ST-Segment Elevation Myocardial Infarction
Juliane Araujo Rodrigues1, Karina Melleu1, Márcia Moura Schmidt1
1Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil.
Insights
Black ethnicity, low income, and diabetes mellitus predict delayed medical care for ST-segment elevation myocardial infarction (STEMI). Identifying these high-risk groups can improve prevention strategies for heart attack patients.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Timely medical intervention is crucial for ST-segment elevation myocardial infarction (STEMI) patients, as delays significantly impact mortality.
- Understanding factors contributing to delayed presentation is essential for improving patient outcomes.
Purpose of the Study:
- To identify independent predictors of late presentation in ST-segment elevation myocardial infarction (STEMI) patients within a real-world clinical setting.
- To inform targeted prevention strategies for high-risk patient subgroups.
Main Methods:
- A prospective study evaluated 1,297 patients diagnosed with STEMI between 2009 and 2014.
- Late presentation was defined as seeking medical care more than 6 hours after chest pain onset.
- Multiple logistic regression analysis identified independent predictors of delayed STEMI treatment.
Main Results:
- Approximately 25% of STEMI patients presented late (>6 hours), experiencing higher mortality.
- Independent predictors of late presentation included Black ethnicity, low income, and diabetes mellitus.
- A history of prior heart disease was found to be a protective factor against late presentation.
Conclusions:
- Black ethnicity, low socioeconomic status, and diabetes mellitus are significant independent predictors of delayed STEMI presentation.
- Identifying at-risk populations is key to developing targeted public health interventions and improving STEMI care pathways.
Background:
In patients with acute ST-segment elevation myocardial infarction (STEMI), the time elapsed from symptom onset to receiving medical care is one of the main mortality predictors.
Objective:
To identify independent predictors of late presentation in patients STEMI representative of daily clinical practice.
Methods:
All patients admitted with a diagnosis of STEMI in a reference center between December 2009 and November 2014 were evaluated and prospectively followed during hospitalization and for 30 days after discharge. Late presentation was defined as a time interval > 6 hours from chest pain onset until hospital arrival. Multiple logistic regression analysis was used to identify independent predictors of late presentation. Values of p < 0.05 were considered statistically significant.
Results:
A total of 1,297 patients were included, with a mean age of 60.7 ± 11.6 years, of which 71% were males, 85% Caucasians, 72% had a mean income lower than five minimum wages and 66% had systemic arterial hypertension. The median time of clinical presentation was 3.00 [1.40-5.48] hours, and approximately one-quarter of the patients had a late presentation, with their mortality being significantly higher. The independent predictors of late presentation were Black ethnicity, low income and diabetes mellitus, and a history of previous heart disease was a protective factor.
Conclusion:
Black ethnicity, low income and diabetes mellitus are independent predictors of late presentation in STEMI. The identification of subgroups of patients prone to late presentation may help to stimulate prevention policies for these high-risk individuals.
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