title: Sex and age specific time patterns and long term time trends of pre-hospital delay of patients presenting with acute ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Prompt initiation of treatment after symptom onset of ST-elevation myocardial infarction (STEMI) is a central goal in limiting myocardial damage because of the time-dependent nature of reperfusion therapies. We examined time patterns and long term time trends of pre-hospital delay time (PHDT) of STEMI patients.
  
  
  METHODS
  PHDT from 3093 STEMI patients derived from the Augsburg Myocardial Infarction Registry (1985-2004) surviving >24h after admission was obtained by a standardized bedside interview. Patients with in-hospital MI (n=140) and resuscitation (n=157) were excluded. Linear regression models were used to examine monthly median PHDT and individual PHDT over time.
  
  
  RESULTS
  Female sex was associated with longer PHDT (189 (98-542quartiles) min vs. 154 (85-497) min; p<0.0003). Median PHDT in the youngest male subgroup (25-54 years) was 128 (73-458) min and mounted to 205 (107-600) min in the oldest female subgroup (65-74 years). A minority of 12.4% of patients reached hospital within 1h of delay ranging from 8.7% (in oldest women) to 15.9% (in youngest men). The age-adjusted linear regression model for monthly PHDT revealed no significant change over 20-year time in both sexes. The corresponding average annual percentage change estimates were -0.45 (95% CI: -1.40 to 0.54) for men and -0.08 (95% CI: -1.80 to 1.67) for women. Emergency ambulance use increased over time, however transportation time remained stable.
  
  
  CONCLUSIONS
  PHDT in STEMI patients is constantly high over a 20-year observation period. Room for improvement especially in older women was evidenced. Preventive strategies with focused efforts on this subgroup are warranted.
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany. ladwig@helmholtz-muenchen.de
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Ladwig
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
authors.forename: Heiko
authors.initials: H
authors.lastname: Hymer
authors.forename: Kathrin
authors.initials: K
authors.lastname: Wolf
authors.forename: Margit
authors.initials: M
authors.lastname: Heier
authors.forename: Wolfgang
authors.initials: W
authors.lastname: von Scheidt
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kuch
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods* / Q000639:trends*; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy*; D012042:Registries; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome