Factors associated with prehospital delay in patients with ST-segment elevation myocardial infarction.

Abstract

Longer ischemia time is known to be related to adverse outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI). Delay in time from symptom onset to emergency department (ED) has been studied less. The aim of this study was to define the clinical, transportation and residential factors associated with longer pre-hospital delay in STEMI events. Total 308 successive patients presenting to Poriya Medical Center with STEMI between Feb 2015 and Dec 2017 were retrospectively identified. The final cohort included 266 patients after excluding inpatient STEMI, files missing time of pain onset and patients in cardiac arrest. Clinical and transport data were retrieved from the cardiology department database. Our primary clinical outcome was 1-year all-cause mortality. Univariable and multivariable logistic regression analyses were performed to define factors associated with prehospital delay. In the total cohort, the patients' mean age was 61 ± 11 years old, 81% were male, and patients lived 21 ± 12 km from our medical center. On multivariable logistic regression analysis, a stop at the community clinic and diabetes were associated with increased risk of a delay. Longer delays were associated with reduced ejection fraction at discharge, higher rates of readmissions and higher all-cause 1-year mortality. The strongest determinant of prehospital delay in STEMI events was seeking first medical care at a community clinic, which was associated with the worst outcomes. This highlights the importance of education of both patients and primary clinic staff regarding the identification and prioritization of STEMI patients and immediate evacuation by emergency medical service.