Patient delay in patients with ST-elevation myocardial infarction: Time patterns and predictors for a prolonged delay.
OBJECTIVE
To improve treatment success of ST-elevation myocardial infarction, a minimal delay from symptom onset to reperfusion therapy is crucial. The patient's response to initial symptoms (patient delay) substantially affects the delay. We investigated time patterns of patient delay during a seven-year time period, and aimed to identify key predictors that affect the length of the patient delay.


METHODS
Data on 5848 patients hospitalized with ST-elevation myocardial infarction and treated with primary percutaneous intervention during the period 2003-2009 were obtained from Danish registry databases. The dependent variable was patient delay (<120 and ⩾120 min). Data were analysed for a possible time trend during the seven-year study period using Jonckheere-Terpstra analysis and we also performed multiple logistical regression to identify predictors of a prolonged patient delay.


RESULTS
We observed a decrease in median patient delay from 101 min in 2003 to 85 min in 2009, p=0.018. We identified the age group 55-69 years (odds ratio (OR): 1.27 (95% confidence interval (CI): 1.09-1.47)) and age ⩾70 years (OR: 1.63 (95% CI: 1.40-1.90)), diabetes (OR: 1.26 (95% CI: 1.05-1.50)), female gender (OR: 1.17 (95% CI: 1.03-1.34)) and presentation during the night 22:00-05:59 (OR: 1.92 (95% CI: 1.68-2.20)), as independent risk factors of a patient delay ⩾120 min. Symptom onset between 14:00-21:59 was associated with a shorter patient delay (OR: 0.78 (95% CI 0.68-0.89)).


CONCLUSIONS
A slight decrease in patient delay during the years from 2003-2009 was observed. High age, diabetes, female gender and symptoms presentation during the night were shown to be independent predictors of prolonged patient delay.
1 Department of Cardiology, Aarhus University Hospital, Denmark.
Christel Ga
CG
Nielsen
1 Department of Cardiology, Aarhus University Hospital, Denmark.
Kristina G
KG
Laut
2 Department of Cardiology, Odense University Hospital, Denmark.
Lisette O
LO
Jensen
3 Department of Cardiology, Aalborg University Hospital, Denmark.
Jan
J
Ravkilde
1 Department of Cardiology, Aarhus University Hospital, Denmark.
Christian J
CJ
Terkelsen
1 Department of Cardiology, Aarhus University Hospital, Denmark.
Steen D
SD
Kristensen
D000368:Aged; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D003695:Delivery of Health Care; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011159:Population Surveillance / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D061665:Time-to-Treatment / Q000639:trends*; D016896:Treatment Outcome
Patient delay; acute coronary syndrome; health care organization; primary percutaneous coronary intervention