Why the study?
Total ischemic time has not significantly improved due to persistent pre-hospital delay in patients with ST-segment elevation myocardial infarction undergoing PCI, prompting investigation into associated risk factors.
What are the risk factors for pre-hospital delay and does EMS utilization reduce symptom-to-door time in patients with STEMI?
What are the risk factors for pre-hospital delay and does EMS utilization reduce symptom-to-door time in patients with STEMI?
Older age, female gender, and renewed ischemia predict pre-hospital delay in STEMI, while EMS utilization significantly shortens symptom-to-door time and is associated with better outcomes in patients with cardiogenic shock.
EMS use may shorten STEMI prehospital delay; extends observational data but leaves open need for prospective trials.
BACKGROUND/AIMS: Minimising total ischemic time (TIT) is important for improving clinical outcomes in patients with ST-segment elevation myocardial infarction who have undergone percutaneous coronary intervention (PCI). TIT has not shown a significant improvement due to persistent pre-hospital delay. This study aimed to investigate the risk factors associated with pre-hospital delay. METHODS: Individuals enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health between 2011 and 2015 were included in this study. The study population was analyzed according to the symptom-to-door time (STDT; within 60 or > 60 minutes), and according to the type of hospital visit (emergency medical services [EMS], non-PCI center, or PCI center). RESULTS: A total of 4,874 patients were included in the analysis, of whom 28.4% arrived at the hospital within 60 minutes of symptom-onset. Old age (> 65 years), female gender, and renewed ischemia were independent predictors of delayed STDT. Utilising EMS was the only factor shown to reduce STDT within 60 minutes, even when cardiogenic shock was evident. The overall frequency of EMS utilisation was low (21.7%). Female gender was associated with not utilising EMS, whereas cardiogenic shock, previous myocardial infarction, familial history of ischemic heart disease, and off-hour visits were associated with utilising EMS. CONCLUSION: Factors associated with delayed STDT and not utilising EMS could be targets for preventive intervention to improve STDT and TIT.
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Lee et al. (2019) studied this question.
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