Sex and age specific time patterns and long term time trends of pre-hospital delay of patients presenting with acute ST-segment elevation myocardial infarction

Abstract

Background Prompt initiation of treatment after symptom onset of ST-elevation myocardial infarction (STEMI) is a central goal in limiting myocardial damage because of the time-dependent nature of reperfusion therapies. We examined time patterns and long term time trends of pre-hospital delay time (PHDT) of STEMI patients. Methods PHDT from 3093 STEMI patients derived from the Augsburg Myocardial Infarction Registry (1985–2004) surviving > 24 h after admission was obtained by a standardized bedside interview. Patients with in-hospital MI (n = 140) and resuscitation (n = 157) were excluded. Linear regression models were used to examine monthly median PHDT and individual PHDT over time. Results Female sex was associated with longer PHDT (189 (98–542 quartiles) min vs. 154 (85–497) min; p < 0.0003). Median PHDT in the youngest male subgroup (25–54 years) was 128 (73–458) min and mounted to 205 (107–600) min in the oldest female subgroup (65–74 years). A minority of 12.4% of patients reached hospital within 1 h of delay ranging from 8.7% (in oldest women) to 15.9% (in youngest men). The age-adjusted linear regression model for monthly PHDT revealed no significant change over 20-year time in both sexes. The corresponding average annual percentage change estimates were −0.45 (95% CI: −1.40 to 0.54) for men and −0.08 (95% CI: −1.80 to 1.67) for women. Emergency ambulance use increased over time, however transportation time remained stable. Conclusions PHDT in STEMI patients is constantly high over a 20-year observation period. Room for improvement especially in older women was evidenced. Preventive strategies with focused efforts on this subgroup are warranted.