Treatment delay in primary PCI in relation to marital status and distance from acute medical care

Abstract

Purpose: Total ischaemic (TI) time following the onset of chest pain is a major determinant of outcome in STEMI. Delay in seeking medical attention (symptom to call time; STC) may contribute significantly to TI time. We assessed whether marital status or distance from nearest medical care (geographical isolation) influenced STC or TI time. Methods: Registry data for PPCI from March 2008 to November 2011 from a large UK tertiary centre serving urban, suburban and rural areas were analysed. Marital status (married/partner vs. others [single, divorced, widowed]) was established. Geographical isolation was defined as the driving time between the patient's home address and nearest hospital (<10mins, 11-20mins and >20 mins). Chest pain onset, call time, 1st device time and TI times were determined. STC time of ≤/>30 minutes, and TI time ≤/>180 minutes were defined a priori as binary outcomes. Multivariable logistic regression was used to define the importance of marital status and time to nearest hospital, adjusting for important covariates including age, sex, infarct location, risk factors, medical history, time of day, direct admission and shock. Results: Mean age was 63.3 (SD 13.4) and 737 (29.4%) were female. 1333 (64.9%) patients were married/with partner. 771 (33.6%) patients lived <10mins from hospital, 1123 (48.9%) 11-20 mins and 403 (17.5%) >20 mins. 1,760 and 1,823 patients were included in the final STC and TI analyses respectively. 1257 (71.4%) patients had a STC time of >30 minutes and and 809 (44.4%) TI >180 mins. Following multivariable analysis, patients who were married/with partner were more likely to seek help within 30 minutes of symptom onset and have TI time of <180 mins. Geographical isolation was not associated with longer STC, but there was an association of borderline significance with longer TI time (table). Table 1 Conclusions: Non-married patients were more likely to delay seeking medical attention and had longer TI times after STEMI onset. In this UK study, geographical location was not associated with STC time, but longer transit times to PPCI centre may influence TI time.