Abstract
BackgroundPre-hospital delay is currently a major factor limiting early reperfusion among ST-elevation myocardial infarction (STEMI) patients worldwide. This study aims to determine pre-hospital factors affecting symptom-to-door time among STEMI patients in Malaysia.MethodsThis cross-sectional study included 222 STEMI patients admitted to two tertiary hospitals in Malaysia. By determining symptom-to-door time, the study population was categorised into two definitive treatment seeking groups: early (≤ 3 h) and delayed (> 3 h). Data was collected focusing on socio-demographical data, risk factors and comorbidities, clinical presentation, situational factors and action taken by patients.ResultsThe mean age of our patients was 58.0 (SD = 11.9) years old, and the population consisted of 186 (83.8%) males and 36 (16.2%) females. Our study found that the median symptom-to-door time was 130.5 (IQR 240) min, with 64% of subjects arriving early and 36% arriving late. Pre-hospital delays were found to be significant among females (adj OR = 2.42; 95% CI: 1.02, 5.76; P = 0.046), patients with recurrence of similar clinical presentations (adj OR = 2.74; 95% CI: 1.37, 5.46; P = 0.004), patients experiencing atypical symptoms (adj OR = 2.64; 95% CI: 1.11, 6.31; P = 0.029) and patients who chose to have their first medical contact (FMC) for their symptoms with a general practitioner (adj OR = 2.80; 95% CI: 1.20, 6.56; P = 0.018). However, patients with hyperlipidaemia (adj OR = 0.46; 95% CI: 0.23, 0.93; P = 0.030), self-perceived cardiac symptoms (adj OR = 0.36; 95% CI: 0.17, 0.73; P = 0.005) and symptoms that began in public places (adj OR = 0.21; 95% CI: 0.06, 0.69; P = 0.010) tended to seek treatment earlier.ConclusionThe symptom-to-door time among the Malaysian population is shorter in comparison to other developing countries. Nevertheless, identified, modifiable pre-hospital factors can be addressed to further shorten symptom-to-door time among STEMI patients.
Highlights
Acute myocardial infarction is a leading cause of mortality worldwide [1]
The aim of this study is to determine the symptom-to-door times of ST-elevation myocardial infarction (STEMI) patients among the Malaysian population and to analyse variables associated with early (≤ 3 h) and late (> 3 h) hospital arrivals by looking at patients’ socio-demographical data, risk factors and comorbidities, symptom characteristics, situational factors and action taken by patients in seeking treatment
Our study revealed the following four factors associated with prolonged symptom-todoor time as predictors of pre-hospital delay: female gender, recurrence of chest pain, atypical symptoms and choosing to see a general practitioners (GP) as first medical contact (FMC)
Summary
Acute myocardial infarction is a leading cause of mortality worldwide [1]. In Malaysia, the 2006–2013 National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVDACS) registry showed a significant increase in the number of patients admitted for acute coronary syndrome (ACS)—from 3,392 in 2006 up to 6,127 in 2013. Among the spectrum of ACS, ST-segment elevation myocardial infarction (STEMI) has remained the most common, with 50.8% of total ACS patients from 2011–2013 [2]. The main reasons for this ineligibility for revascularisation were late arrival at emergency departments and doctors having missed the diagnosis of STEMI [2], both of which lead to increased mortality and morbidity. Pre-hospital delay is currently a major factor limiting early reperfusion among ST-elevation myocardial infarction (STEMI) patients worldwide. This study aims to determine pre-hospital factors affecting symptom-to-door time among STEMI patients in Malaysia
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