The association between pre-infarction angina and care-seeking behaviors and its effects on early reperfusion rates for acute myocardial infarction.
OBJECTIVE
To examine the association between pre-infarction angina (PA) and care-seeking behaviors and its effects on early reperfusion rates for patients with ST-elevation myocardial infarction (STEMI).


METHODS
Between November 1, 2005 and December 31, 2006, a prospective, cross-sectional, and multicenter survey was conducted in 19 hospitals in Beijing and included consecutive patients with STEMI admitted within 12 h of onset of symptoms. Data were collected by structured interviews and medical records review.


RESULTS
PA within 48 h prior to the onset of the infarction occurred in 50.4% of the 498 patients. Prior to seeking care, patients in the PA group more frequently thought the symptoms would go away (61.8% vs. 38.5%, p < 0.001) and attempted some form of self-treatment (61.0% vs. 45.3%, p = 0.001) than the patients without PA (non-PA group). Median pre-hospital delay in the PA group was longer (118 vs. 103 min, p = 0.045) than in the non-PA group. The prevalence of ambulance use in the PA group was significantly lower than in the non-PA group (31.5% vs. 43.3%, p = 0.007). Multivariate analysis showed that the presence of PA was an independent predictor of pre-hospital delay >2 h (OR 1.863, 95% CI: 1.112-2.765, p = 0.013) and non-ambulance use (OR 1.724, 95% CI: 1.185-2.670, p = 0.003). In addition, patients in the PA group had a lower early reperfusion rate (74.7% vs. 83.3%, p = 0.027), mainly because of a lower incidence of primary percutaneous coronary intervention (58.6% vs. 67.9%, p = 0.042).


CONCLUSIONS
Presence of PA was associated with longer pre-hospital delay, significantly decreased use of ambulance, and lower early reperfusion rates among patients with STEMI.
The 28th Division, Beijing Anzhen Hospital of the Capital University of Medical Science, Beijing, China.
Hongbing
H
Yan
Li
L
Song
Jingang
J
Yang
Yihong
Y
Sun
Dayi
D
Hu
D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data; D000787:Angina Pectoris / Q000453:epidemiology* / Q000628:therapy*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003657:Decision Making; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000517:prevention & control*; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data