title: [Accessibility to health care of diabetic patients with acute coronary syndrome ST-segment elevation].
abstract: OBJECTIVE
  To measure accessibility to health care among diabetic patients and analyze whether differences in delay explain differences in hospital mortality.
  
  
  METHODS
  A retrospective cohort study was conducted in diabetic patients with acute coronary syndrome with ST-segment elevation included in the ARIAM-SEMICYUC registry (2010-2013). Crude and adjusted analyses were performed using unconditional logistic regression.
  
  
  RESULTS
  A total of 4817 patients were analyzed, of whom 1070 (22.2%) were diabetics. No differences were found in access to health care between diabetic and non-diabetic patients. Diabetic patients presented with longer patient delay (90 min vs. 75 min; p=.004) and prehospital delay (150 min vs. 130 min; p=.002). Once the health system was contacted, diabetic patients had a lower reperfusion rate (50% vs. 57.7%; p<.001), but no longer delay in treatment was observed compared with the non-diabetic individuals. Diabetic patients have greater in-hospital mortality (12.5 vs. 6%; p <.001), though neither patient delay nor prehospital delay were identified as independent predictors of in-hospital mortality.
  
  
  CONCLUSIONS
  Diabetic patients had a longer delay in access to health care, though such delay was not independently related to increased mortality.
authors.affiliation: Unidad de Cuidados Intensivos, Hospital General Universitario de Elche, Elche, España. Electronic address: anna.baeza@coma.es.
authors.forename: A
authors.initials: A
authors.lastname: Baeza-Román
authors.affiliation: Unidad de Cuidados Intensivos, Hospital General Universitario de Elche, Elche, España.
authors.forename: E
authors.initials: E
authors.lastname: de Miguel-Balsa
authors.affiliation: Unidad de Cuidados Intensivos, Hospital General Universitario de Elche, Elche, España.
authors.forename: J
authors.initials: J
authors.lastname: Latour-Pérez
authors.affiliation: Unidad de Cuidados Intensivos, Complejo Hospital San Pedro. Logroño, España.
authors.forename: V
authors.initials: V
authors.lastname: Díaz de Antoñana-Saez
authors.affiliation: Unidad de Cuidados Intensivos, Hospital General de Castelló, Castellón. España.
authors.forename: J
authors.initials: J
authors.lastname: Arguedas-Cervera
authors.affiliation: Unidad de Cuidados Intensivos, Hospital General Universitario Reina Sofía. Murcia, España.
authors.forename: E
authors.initials: E
authors.lastname: Mira-Sánchez
authors.affiliation: Unidad de Cuidados Intensivos, Complejo hospitalario Arquitecto Marcide-Prof. Novoa Santos, Ferrol, España.
authors.forename: C J
authors.initials: CJ
authors.lastname: Fernández-González
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Arnau de Vilanova, Valencia, España.
authors.forename: M
authors.initials: M
authors.lastname: Rico-Sala
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Nuestra Señora de Gracia, Zaragoza, España.
authors.forename: M
authors.initials: M
authors.lastname: Lafuente-Mateo
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D015331:Cohort Studies; D003920:Diabetes Mellitus; D004562:Electrocardiography; D006297:Health Services Accessibility; D017052:Hospital Mortality; D006801:Humans; D009203:Myocardial Infarction; D012189:Retrospective Studies
keywords: Accesibilidad; Access; Acute coronary syndrome with ST-segment elevation; Delay; Diabetes mellitus; Health care; Retraso; Sistema sanitario; Síndrome coronario agudo con elevación de ST