Pre-hospital delay and emergency medical services in acute myocardial infarction
Seung Hun Lee1,2, Hyun Kuk Kim3, Myung Ho Jeong1
1Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Insights
Pre-hospital delay in ST-segment elevation myocardial infarction (STEMI) patients prolongs total ischemic time (TIT). Older age, female gender, and renewed ischemia predict delays, while emergency medical services (EMS) use can reduce delays.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Minimizing total ischemic time (TIT) is crucial for ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI).
- Persistent pre-hospital delays hinder TIT improvement, impacting clinical outcomes.
- Understanding pre-hospital delay risk factors is essential for timely intervention.
Purpose of the Study:
- To investigate risk factors associated with pre-hospital delay in STEMI patients.
- To identify predictors of delayed symptom-to-door time (STDT).
- To evaluate the impact of emergency medical services (EMS) utilization on STDT.
Main Methods:
- Analysis of 4,874 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (2011-2015).
- Stratification of patients based on STDT (≤60 minutes vs. >60 minutes).
- Comparison of hospital visit types: EMS, non-PCI center, and PCI center.
Main Results:
- 28.4% of patients arrived within 60 minutes of symptom onset.
- Independent predictors of delayed STDT included older age (>65 years), female gender, and renewed ischemia.
- EMS utilization (21.7%) was the only factor reducing STDT, even in cardiogenic shock; female gender was linked to lower EMS use.
Conclusions:
- Delayed STDT and low EMS utilization present targets for intervention.
- Interventions focusing on identified risk factors can improve STDT and reduce TIT.
- Promoting EMS use is vital for improving STEMI patient outcomes.
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.
Conclusion:
Factors associated with delayed STDT and not utilising EMS could be targets for preventive intervention to improve STDT and TIT.
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