Delays in management of ST-segment elevation myocardial infarction

Abstract

The first medical contact delay or latency-patient time is the first time in the decision of Acute Coronary Syndrome support, including STEMI which prognosis depends on early myocardial reperfusion. Our study aimed to determine the factors influencing this FMC-delay. The population was a part of the study “TEPS-ACS 2009-2010” which was directed by the research laboratory of epidemiology and prevention of cardiovascular disease in Tunisia. We selected patients who were hospitalized for a STEMI and whose diagnosis was made in the first 24 hours of the onset of symptoms. We included 445 patients (79% male), mean age 60 ± 12 years. The average time of FMC-delay was 4.27 ± 5,30 h with a median of 2 hours. This period was significantly longer in women, patients older than 65 years old, widowed or divorced. This period was also longer in diabetic patients and those with a history of myocardial infarction. This period was shorter in smokers. The study of the nature of the first medical contact has shown that patients who were carried by the mobile emergency medical service or viewed directly in hospital emergency had significantly shorter time than those who visited a private doctor. In multivariate analysis, only the female gender was the independent factor related to a longer FMC-delay (adjusted OR = 1.87; P = 0.002). The FMC-delay is influenced by demographic, socioeconomic and epidemiological factors. The public awareness of the clinical manifestations of coronary emergencies and development of medical transport are the first solution to shorten the time of reperfusion and improve the prognosis of STEMI.