In-depth look into urban and rural disparities in prehospital delay in patients with acute ST-elevation myocardial infarction and its impact on prognosis: a prospective observational study

ObjectivesIn 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.DesignProspective observational study.SettingThis study was conducted in a tertiary hospital, the only nationally accredited chest pain centre with percutaneous coronary intervention (PCI) capacity in Pizhou, China.Participants394 patients with STEMI without patients with in-hospital STEMI or patients lost to follow-up were included.Primary outcome measuresPrimary outcome was major adverse cardiovascular events (MACEs), including cardiac death, non-fatal myocardial infarction and heart failure.ResultsAmong 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