title: 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.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
authors.forename: Yong Hwan
authors.initials: YH
authors.lastname: Park
authors.forename: Gu Hyun
authors.initials: GH
authors.lastname: Kang
authors.forename: Bong Gun
authors.initials: BG
authors.lastname: Song
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Chun
authors.forename: Jun Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Seong Youn
authors.initials: SY
authors.lastname: Hwang
authors.forename: Ju Hyeon
authors.initials: JH
authors.lastname: Oh
authors.forename: Kyungil
authors.initials: K
authors.lastname: Park
authors.forename: Young Dae
authors.initials: YD
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000368:Aged; D003710:Demography; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013997:Time Factors; D014218:Triage