Abstract
BackgroundThe length of time between symptom onset and reperfusion therapy in patients with ST-segment elevation acute myocardial infarction (STEMI) is a key determinant of mortality. Information on this delay is scarce, particularly for developing countries. The objective of the study is to prospectively evaluate the individual components of reperfusion time (RT) in patients with STEMI treated at a University Hospital in 2012.MethodsMedical records were reviewed to determine RT, its main (patient delay time [PDT] and system delay time [SDT]) and secondary components and hospital access variables. Cognitive responses were evaluated using a semi-structured questionnaire.ResultsA total of 50 patients with a mean age of 59 years (SD = 10.5) were included, 64% of whom were male. The median RT was 430 min, with an interquartile range of 315–750 min. Regarding the composition of RT in the sample, PDT corresponded to 18.9% and SDT to 81.1%. Emergency medical services were used in 23.5% of cases. Patients treated in intermediate care units showed a significant increase in SDT (p = 0.008). Regarding cognitive variables, PDT was approximately 40 min longer among those who answered “I didn’t think it was serious” (p = 0.024).ConclusionsIn a Brazilian tertiary public hospital, RT was higher than that recommended by international guidelines, mainly because of long SDT, which was negatively affected by time spent in intermediate care units. Emergency Medical Services underutilization was noted. A patient’s low perception of severity increased PDT.
Highlights
The length of time between symptom onset and reperfusion therapy in patients with ST-segment elevation acute myocardial infarction (STEMI) is a key determinant of mortality
The Patient delay time (PDT) corresponded to 18.9% of reperfusion time (RT) (45 min, IQT: 30–140), while the System delay time (SDT) accounted for 81.1% of total time, with a median of 319 min (ITQ: 220–615)
This study evaluated the components of RT and the variables related to it in STEMI patients treated by primary percutaneous coronary intervention (PCI) in the largest public hospital in the state of Paraná, Brazil, during 2012
Summary
The length of time between symptom onset and reperfusion therapy in patients with ST-segment elevation acute myocardial infarction (STEMI) is a key determinant of mortality. Information on this delay is scarce, for developing countries. According to the Brazilian Unified Health System’s Database, cardiovascular disease accounted for 10% of all hospitalizations and more than one-third of deaths in Brazil [1]. Acute coronary syndromes (ACS) represent a major cause of hospitalization and are the third leading cause of hospitalization in the Unified Health System [2]. The majority of deaths from ST-segment elevation acute myocardial infarction (STEMI) occur in the first. When the reasons for the delay in patients seeking help are evaluated, a multiplicity of factors is revealed, including the context in which the symptoms appear, socioeconomic variables, cognitive and emotional responses and the reactions of witnesses [10,11,12]
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