title: Patient characteristics associated with self-presentation, treatment delay and survival following primary percutaneous coronary intervention.
abstract: BACKGROUND
  Delayed arrival to a primary percutaneous coronary intervention (PPCI)-capable hospital following ST-elevation myocardial infarction (STEMI) is associated with poorer outcome. The influence of patient characteristics on delayed presentation during STEMI is unknown.
  
  
  RESULTS
  This was a retrospective observational study. Patients presenting for PPCI from March 2008 to November 2011 in the north of England (Northumbria, Tyne and Wear) were included. The outcomes were self-presentation to a non-PPCI-capable hospital, symptom to first medical contact (STFMC) time, total ischaemic time and mortality during follow-up. STEMI patients included numbered 2297; 619 (26.9%) patients self-presented to a non-PPCI-capable hospital. STFMC of >30 min and total ischaemic time of >180 min was present in 1521 (70.7%) and 999 (44.9%) cases, respectively. Self-presentation was the strongest predictor of prolonged total ischaemic time (odds ratio, OR (95% confidence interval, CI): 5.05 (3.99-6.39)). Married patients (OR 1.38 (1.10-1.74)) and patients living closest to an Emergency Room self-presented more commonly (driving time (vs. ≤10 min) 11-20 min OR 0.66 (0.52-0.83), >20 minutes OR 0.46 (0.33-0.64). Unmarried females waited longest to call for help (OR vs. married males 1.89 (1.29-2.78) and experienced longer total ischaemic times (OR 1.51 (1.10-2.07)). Married patients had a borderline association with lower mortality (hazard ratio 0.75 (0.53-1.05), p=0.09).
  
  
  CONCLUSIONS
  Unmarried female patients had the longest treatment delays. Married patients and those living closer to an Emergency Room self-present more frequently. Early and exclusive use of the ambulance service may reduce treatment delay and improve STEMI outcome.
authors.affiliation: Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK.
authors.forename: David
authors.initials: D
authors.lastname: Austin
authors.affiliation: Department of Cardiology, St Michael's Hospital, University of Toronto, Canada.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
authors.affiliation: Department of Cardiology, Forth Valley Hospital, Larbert, UK.
authors.forename: James C
authors.initials: JC
authors.lastname: Spratt
authors.affiliation: Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Vijay
authors.initials: V
authors.lastname: Kunadian
authors.affiliation: Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Edwards
authors.affiliation: Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Mohaned
authors.initials: M
authors.lastname: Egred
authors.affiliation: Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK alan.bagnall@nuth.nhs.uk.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Bagnall
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017678:Sex Distribution; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: ST elevation myocardial infarction; angioplasty; gender