Related Experiment Video
Updated: Jan 20, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Pre-Hospital Delay and Its Contributing Factors in Patients with ST-Elevation Myocardial Infarction; a Cross
Hamidreza Poorhosseini1, Mohammad Saadat2, Mojtaba Salarifar1
1Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Pre-hospital delay in ST-elevation myocardial infarction (STEMI) remains high in Iran, with factors like female gender, lack of education, and specific symptom timings contributing to longer pain-to-door times. Public awareness campaigns are crucial for prompt STEMI treatment.
Area of Science:
- Cardiology
- Public Health
Background:
- ST-elevation myocardial infarction (STEMI) outcomes are critically dependent on minimizing tissue ischemic time.
- While primary percutaneous coronary intervention (P-PCI) is available 24/7, pre-hospital delays persist, impacting patient outcomes.
- This study is the first in Iran to investigate pre-hospital delay duration and its determinants in STEMI patients undergoing P-PCI.
Purpose of the Study:
- To assess the duration of pre-hospital delay in STEMI patients in Iran.
- To identify demographic, clinical, and socioeconomic factors associated with pre-hospital delay in the P-PCI era.
Main Methods:
- A cross-sectional study involving 2103 STEMI patients who underwent P-PCI between 2016 and 2018.
- Data collected included patient demographics, socioeconomic status, medical history, and event characteristics (pain onset, door time).
- Multivariate analysis was used to determine independent factors influencing pre-hospital delay (pain to door time).
Main Results:
- The median pain to door (P2D) time was 279 minutes (IQR: 120-630).
- Factors significantly associated with longer P2D included female gender, lower education, chest pain onset during early morning/late morning, self-transportation, referral from another hospital, atypical chest pain, hypertension history, and opium abuse.
- History of coronary artery bypass grafting (CABG) was associated with shorter P2D.
Conclusions:
- Pre-hospital delay (P2D) in STEMI patients in Iran is notably high.
- Specific patient groups and circumstances are identified as high-risk for prolonged delays.
- Enhanced public awareness regarding STEMI symptoms and the urgency of seeking appropriate medical help is essential.
Introduction:
The outcome of ST-elevation myocardial infarction (STEMI) is significantly influenced by the total tissue ischemic time. In spite of efforts for reducing the in-hospital delay by full-time provision of primary percutaneous coronary intervention (P-PCI) in the 24/7 program, pre-hospital delay still persists. As a first report in Iran, we aimed to assess the duration of pre-hospital delay and its contributing factors in STEMI patients in the P-PCI era.
Methods:
The present cross-sectional study evaluated 2103 STEMI patients who underwent primary PCI from 2016 to 2018. Demographic, personal and socioeconomic factors, index event characteristics, past medical history, pain onset and door times of patients were recorded and independent factors of pre-hospital delay were calculated.
Results:
Median (IQR) of pain to door (P2D) time was 279 (120-630) minutes. In multivariate analysis, female gender [Beta=0.064 (95%CI: 0.003-0.125); p=0.038], being uneducated [Beta=0.213 (95%CI: 0.115-0.311); p<0.001], the onset of chest pain between 00:00 to 6:00 [Beta=0.130 (95%CI: 0.058-0.202); p<0.001] or 7:00 to 12:00 [Beta=0.119 (95%CI: 0.049-0.190); p=0.001], self-transportation [Beta=0.098 (95%CI: 0.015-0.181); p=0.020] or referral from another hospital [Beta=0.253 (95%CI: 0.117-0.389); p<0.001], atypical chest pain [Beta=0.170 (95%CI: 0.048-0.293); p=0.006], history of hypertension [Beta=0.052 (95%CI: 0.002-0.102); p=0.041], and opium abuse [Beta=0.076 (95%CI: 0.007-0.146); p=0.031] were associated with a significantly higher log(P2D), while history of CABG was associated with shorter P2D.
Conclusion:
Our study showed that P2D is still very high in Iran and revealed the high-risk groups associated with longer P2D. Effective actions should be implemented to increase the public awareness about the symptoms of STEMI, and the importance of immediate appropriate help-seeking.
Related Concept Videos
01:50Cross-Sectional Research
00:59Hospitals-II
Nurses that work in...
01:26Profile Leveling and Cross Sections
01:28Hospitals-I
01:16Spinal Cord: Cross-sectional Anatomy
Gray Matter and its Components
Central to the gray matter is...
01:29Factors Affecting Protein-Drug Binding: Patient-Related Factors
Age stands as a key determinant in protein-drug binding. Neonates, characterized by low albumin content, experience heightened concentrations of unbound drugs such as phenytoin and...