title: Symptom-to-door delay among patients with ST-segment elevation myocardial infarction in Singapore.
abstract: OBJECTIVE
  Symptom-to-door time (S2D) is one of the important components of ischaemic time, which might affect the infarct size and outcomes of acute myocardial infarction. The aim of the present study was to identify patients' characteristics associated with delayed symptom-onset-to-arrival at EDs in ST-segment elevation myocardial infarction (STEMI) patients in Singapore.
  
  
  METHODS
  Retrospective data of STEMI patients presenting to the ED of all public hospitals with onsite primary percutaneous coronary intervention facilities between 2010 and 2012 were obtained from the Singapore Myocardial Infarction Registry. Based on the S2D of 120 min, characteristics of patients were compared between short S2D (≤120 min) and long S2D (>120 min). Multivariate logistic and linear regression analyses were performed.
  
  
  RESULTS
  Out of 3848 patients, 1682 patients had an S2D of ≤120 min, and 2166 had an S2D >120 min. In the multivariate analyses, older age, Malay ethnicity, diabetes mellitus, presenting symptoms of back and epigastric pain were independently associated with long S2D. Patients who utilised the emergency medical services, presented after office hours and with symptoms of chest pain, breathlessness, diaphoresis and past history of percutaneous transluminal coronary angioplasty/primary percutaneous coronary intervention, were independently associated with short S2D. Patients with long S2D had lower probability of receiving reperfusion treatment with delayed symptom-to-balloon and door-to-balloon time and higher probabilities of complications and mortality.
  
  
  CONCLUSIONS
  The present study shows that longer S2D was associated with older age, ethnicity, diabetes mellitus, delay in receiving early reperfusion treatment and poorer prognosis.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Win
authors.initials: W
authors.lastname: Wah
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Pin Pin
authors.initials: PP
authors.lastname: Pek
authors.affiliation: Emergency Medicine Residency Program, SingHealth Services, Singapore.
authors.forename: Andrew Fu Wah
authors.initials: AF
authors.lastname: Ho
authors.affiliation: Division of Research, Singapore General Hospital, Singapore.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fook-Chong
authors.affiliation: National Registry of Diseases Office, Health Promotion Board, Singapore.
authors.forename: Huili
authors.initials: H
authors.lastname: Zheng
authors.affiliation: National Registry of Diseases Office, Health Promotion Board, Singapore.
authors.forename: En Yun
authors.initials: EY
authors.lastname: Loy
authors.affiliation: Department of Cardiology, National Heart Centre, Singapore.
authors.forename: Terrance Siang Jin
authors.initials: TS
authors.lastname: Chua
authors.affiliation: Department of Cardiology, National Heart Centre, Singapore.
authors.forename: Tian Hai
authors.initials: TH
authors.lastname: Koh
authors.affiliation: National Registry of Diseases Office, Health Promotion Board, Singapore.
authors.forename: Khuan Yew
authors.initials: KY
authors.lastname: Chow
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Arul
authors.initials: A
authors.lastname: Earnest
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Junxiong
authors.initials: J
authors.lastname: Pang
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.|Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
mesh_terms: D000368:Aged; D057210:Delayed Diagnosis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015425:Myocardial Reperfusion; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis*; D012846:Singapore; D063189:Symptom Assessment / Q000379:methods* / Q000592:standards*; D013997:Time Factors
keywords: epidemiology; mortality; myocardial infarction; prehospital emergency care