Association of educational level with delay of prehospital care before reperfusion in STEMI.
OBJECTIVE
Rapid access to reperfusion is important in ST-segment elevation myocardial infarction (STEMI). The goal of this study is to assess the association of the educational level of patients with STEMI and prehospital and inhospital delay before reperfusion.


METHODS
We used a nationwide database of 31 emergency departments for cardiovascular disease surveillance operated by the Korean Centers for Disease Control and Prevention. ST-segment elevation myocardial infarction cases registered from November 2007 to December 2012 were enrolled. Cases younger than 18 years old or missing educational history were excluded. Educational level was characterized as low (completion of elementary school or less), medium (completion of middle or high school), and high (completion of a bachelor's degree or higher). We compared prehospital and inhospital delay for 3 educational groups. A general linear regression was used to assess the association of educational level with the time from symptom to hospital arrival.


RESULTS
A total of 9028 patients with STEMI were included. The median time from symptom to hospital arrival was 144, 76, and 68 minutes in the low, medium, and high education groups, respectively (P < .01). Educational level had no significant effect on the door-to-balloon time. Low and medium education groups experienced significant delays of symptom to hospital to high education group (low: β = 27.2 minutes; 95% confidence interval, 15.9-38.5; medium: β = 19.1 minutes; 95% confidence interval, 15.9-38.5).


CONCLUSIONS
In patients with STEMI, the time from symptom to hospital arrival increased as educational level decreased, but educational level had no significant association with the inhospital delay to reperfusion.
Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
Ju Yeon
JY
Heo
Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea. Electronic address: emkjhong@gmail.com.
Ki Jeong
KJ
Hong
Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
Sang Do
SD
Shin
Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
Kyoung Jun
KJ
Song
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
Young Sun
YS
Ro
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004522:Educational Status; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D015425:Myocardial Reperfusion; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D056910:Republic of Korea; D061665:Time-to-Treatment; D055815:Young Adult