title: Alexithymia affects the time from symptom onset to calling the emergency system in STEMI patients referred for primary PCI.
abstract: BACKGROUND
  STEMI programs have been found to reduce the time to reperfusion but do not address the time delay caused by patients. In this study we sought to assess whether and to what extent alexithymia, defined as the inability to recognize and describe somatic feelings appropriately, impacts on this delay.
  
  
  METHODS
  Ninety-five STEMI patients referred by the Emergency Medical System (EMS) to our hospital for primary percutaneous coronary intervention were studied. The time from symptom onset to the EMS call (time to call) as well as the time from the EMS call to the first intervention that restored patency of the culprit vessel (system delay) and the total ischemic time was calculated in patients categorized into two groups according to the Toronto Alexithymia scale (TAS-20): patients with higher alexithymia scores (≥61), and patients with lower scores of alexithymia (<61).
  
  
  RESULTS
  According to the TAS-20, we identified 27 patients as being alexithymic and 68 patients as not. The time to call and the total ischemic time were longer in alexithymic compared to non alexithymic patients (respectively, 159min vs 35min, and 258.5 vs 139 , p=0.001), while the system delay was similar in both groups.
  
  
  CONCLUSIONS
  Alexithymia is one trait of the patient personality which appears to have negative implications in the setting of a STEMI network by interfering with prompt seeking of care. This information could help in guiding novel strategies to motivate patients to call EMS quickly and further shorten the total ischemic time.
authors.affiliation: Clinical Cardiology, Ospedale San Giovanni di Dio, AOU Cagliari, Department of Medical Science M. Aresu, University of Cagliari, Italy. Electronic address: luigimeloni@medicina.unica.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Meloni
authors.affiliation: Clinical Cardiology, Ospedale San Giovanni di Dio, AOU Cagliari, Department of Medical Science M. Aresu, University of Cagliari, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Montisci
authors.affiliation: Clinical Cardiology, Ospedale San Giovanni di Dio, AOU Cagliari, Department of Medical Science M. Aresu, University of Cagliari, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Pippia
authors.affiliation: Center for Consultation-Liaison Psychiatry and Psychosomatics, Department of Public Health, Ospedale San Giovanni di Dio, University of Cagliari, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Sancassiani
authors.affiliation: Center for Consultation-Liaison Psychiatry and Psychosomatics, Department of Public Health, Ospedale San Giovanni di Dio, University of Cagliari, Italy.
authors.forename: Mauro G
authors.initials: MG
authors.lastname: Carta
mesh_terms: D000342:Affective Symptoms / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D000368:Aged; D004632:Emergency Medical Services / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000639:trends*; D012017:Referral and Consultation / Q000639:trends*; D000072657:ST Elevation Myocardial Infarction / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D057566:Self Report; D061665:Time-to-Treatment / Q000639:trends*
keywords: Alexithymia; Delay in seeking care; Emergency medical system; Primary PCI; STEMI