title: Impact of first contact on symptom onset-to-door time in patients presenting for primary percutaneous coronary intervention.
abstract: OBJECTIVE
  To determine effect of first medical contact type on symptom onset-to-door time (SODT).
  
  
  BACKGROUND
  Shorter total ischemic time is associated with improved outcomes in ST-elevation myocardial infarction.
  
  
  METHODS
  From 2005 to 2009, we reviewed records of all consecutive patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction at our tertiary care teaching hospital (median follow-up 3.85 years). We compared SODT in patients whose first medical contact was a private physician (in person or via telephone) vs patients who presented to the emergency department (ED) directly (in person or via Emergency Medical Services).
  
  
  RESULTS
  Of 366 patients, 84 (23%) contacted a physician (group A) while 282 (77.6%) did not (group B). Group A had higher median SODT (239.5 vs 130 minutes, P = .0043) and significantly higher mortality (log rank P = .0392, Cox Proportional Hazard Model risk factors: physician contact first [P < .013], age [P < .0001] and peripheral vascular disease [P < .035]). Two factors associated with prolonged SODT: (1) contacting a physician first P = .002 and (2) personal mode of transportation, P = .002. Patients presenting during "on-hours" (weekdays) were more likely to first contact a physician compared with those presenting during "off-hours" (weeknights and weekends) (66.67% in group A vs 45.04% in group B, P < .001).
  
  
  CONCLUSIONS
  Patients whose first medical contact was a physician had greater pre-hospital delays and worse survival compared to those who sought emergent medical care directly. This pattern occurred more often during "on-hours." Educational efforts aimed at both patient and physician office practices are warranted.
authors.affiliation: Division of Cardiology, Winthrop University Hospital, Mineola, NY 11501, USA.
authors.forename: Abdul Moiz
authors.initials: AM
authors.lastname: Hafiz
authors.forename: Srihari S
authors.initials: SS
authors.lastname: Naidu
authors.forename: Joshua
authors.initials: J
authors.lastname: DeLeon
authors.forename: Shahidul
authors.initials: S
authors.lastname: Islam
authors.forename: Basil
authors.initials: B
authors.lastname: Alkhatib
authors.forename: Miguel
authors.initials: M
authors.lastname: Lorenz
authors.forename: Alexis
authors.initials: A
authors.lastname: D'Elia
authors.forename: Barry
authors.initials: B
authors.lastname: Rosenthal
authors.forename: Kevin
authors.initials: K
authors.lastname: Marzo
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014186:Transportation / Q000706:statistics & numerical data