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

• Published in: Journal of Korean medical science Vol. 27; no. 8; pp. 864 - 869
• Main Authors: Park, Yong Hwan, Kang, Gu Hyun, Song, Bong Gun, Chun, Woo Jung, Lee, Jun Ho, Hwang, Seong Youn, Oh, Ju Hyeon, Park, Kyungil, Kim, Young Dae
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 01.08.2012; 대한의학회
• Subjects: Acute Disease; Aged; Demography; Electrocardiography; Emergency Service, Hospital; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Original; Retrospective Studies; Socioeconomic Factors; Time Factors; Triage; 의학일반; Prehospital Delay; Myocardial Infarction; Mortality
• ISSN: 1011-8934; 1598-6357; 1598-6357
• DOI: 10.3346/jkms.2012.27.8.864

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.