Key result
Rural living links to prolonged symptom-to-door time but similar adjusted MACE risk versus urban patients.
Why the study?
The difference in prehospital delay between urban and rural areas of China and its impact on prognosis in STEMI was unclear.
Does rural residence increase prehospital delay and MACEs in patients with STEMI compared to urban residence?
Observational (n=394)
No
Does rural residence increase prehospital delay and MACEs in patients with STEMI compared to urban residence?
Rural patients with STEMI experience longer prehospital delays, which is the primary driver of their higher incidence of major adverse cardiovascular events compared to urban patients.
Answers are grounded in this paper and cite their sources.
Rural STEMI patients show delay-linked unadjusted MACE excess; hypothesis-generating for targeted interventions before practice change.
OBJECTIVES: In line with the cardiac fast track, the 'green pathway for patients with heart attack' policy in China is implemented to reduce door-to-balloon time in patients with ST-segment elevation myocardial infarction (STEMI). However, the difference in prehospital delay between urban and rural areas of China and its impact on prognosis is unclear. DESIGN: Prospective observational study. SETTING: This study was conducted in a tertiary hospital, the only nationally accredited chest pain centre with percutaneous coronary intervention (PCI) capacity in Pizhou, China. PARTICIPANTS: 394 patients with STEMI without patients with in-hospital STEMI or patients lost to follow-up were included. PRIMARY OUTCOME MEASURES: Primary outcome was major adverse cardiovascular events (MACEs), including cardiac death, non-fatal myocardial infarction and heart failure. RESULTS: Among 394 patients enrolled, 261 (66.2%) were men, the median age was 69 years (interquartile range: 61-77 years), and 269 (68.3%) were from rural areas. Symptom-to-door (S2D) time was significantly longer for rural patients than for urban patients (p<0.001). Cox regression analyses revealed living in rural areas was independently associated with prolonged S2D time (adjusted HR 0.59; 95% CI 0.43 to 0.81; p=0.001). HR of <1 indicates that the S2D time is longer for patients in the rural group (group of interest). During 1-year follow-up, the incidence of MACEs was higher in rural patients (p=0.008). The unadjusted OR for MACEs between rural and urban patients was 2.22 (95% CI 1.22 to 4.01). Adjusting for sex did not attenuate the association (OR 2.06; 95% CI 1.13 to 3.76), but after further adjusting for age, cardiac function classification, S2D time and performance of primary PCI, we found that odds were similar for rural and urban patients (OR 1.19; 95% CI 0.59 to 2.38). CONCLUSIONS: Rural patients with STEMI had a longer S2D time, which led to a higher incidence of MACEs. This study provides rationales for taking all the measures to avoid prehospital delay.
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Shen et al. (2022) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=394). Living in rural areas vs. Living in urban areas was evaluated on Major adverse cardiovascular events (MACEs), including cardiac death, non-fatal myocardial infarction and heart failure (OR 1.19, 95% CI 0.59 to 2.38). Living in rural areas was associated with prolonged symptom-to-door time and higher unadjusted MACEs, though odds were similar to urban patients after full adjustment (OR 1.19; 95% CI 0.59-2.38).
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