Factors Related to Prehospital Time Delay in Acute ST-Segment Elevation Myocardial Infarction

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.

Factors associated with pre-hospital delay before reperfusion therapy in patients with ST-segment elevation myocardial infarction

“…[15] While a study conducted in China confirmed about the mean delay of 23.58 hrs (SD=85.09) which is relatively higher than the present study. [14] The present study revealed the median duration of prehospital delay is eight hrs which is comparatively higher than other studies where lesser median delay times were reported in Korea (2.5 hrs), [16] Beijing (2.3 hrs), [17] and Chennai (three hrs). [18] The present study highlights the door to needle time was 54 min (SD=24) which is comparable to the study from South India and Beijing which depicted the median door-to-needle time were 75 and 82 min respectively.…”

Prehospital delay and time to reperfusion therapy in ST elevation myocardial infarction

“…In contrast to this, the previous studies have reported that the presence of diabetes was associated with increased delay. [1420] There was no significant difference in delay times with respect to the history of hypertension, history of smoking/alcoholism, or history of CAD. However, another study reported that history of MI/CAD was associated with reduced delay.…”

Predictors of Prehospital Delay in Patients With Acute Myocardial Infarction in Kashan City

“…These findings were consistent with studies conducted by Momeni et al in Iran (9) and Peng et al (21) and Qian et al (14) in China who found that the type of transportation vehicle and the location of residency were associated with prehospital delay. However, some studies in Korea (13), Bushehr (10), and Bandar-Abbas (18) have found that residency and type of transportation vehicle were not associated with prehospital delay. Currently the EMS stations are mainly located within cities and then the delay time would be more in suburbs.…”

“…The reported mean time from onset of chest pain to hospital admission ranges from 273 ± 258 to 1302 ± 1524 minutes in different cities (9-11), and a delay over 180 minutes was observed in 70% of patients with AMI in Tehran City (11). The mean delay has been reported to be 185.2 ± 334.8 minutes in Turkey (12), 255 ± 285 minutes in Korea (13), and 1415 ± 5105 minutes in China (14). In addition, the median delay was 216 minutes in London (15), and 56.2% of patients presented to a hospital within 240 minutes of symptom onset in India (16).…”