Predictors of pre-hospital delay in patients with ST-segment elevation myocardial infarction
Early reperfusion therapy in ST-elevation myocardial infarction (STEMI) correlates with its success. The aim of our study was to characterize patients admitted with a diagnosis of STEMI with longer prehospital delay and to analyze its impact on the choice of treatment and on in-hospital prognosis. W...
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| Veröffentlicht in: | Revista portuguesa de cardiologia 2010-10, Vol.29 (10), p.1521-1532 |
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| creator | Ribeiro, Sílvia Gaspar, Antonio Rocha, Sérgia Nabais, Sérgio Azevedo, Pedro Salgado, Alberto Pereira, Miguel Alvares Correia, Adelino |
| description | Early reperfusion therapy in ST-elevation myocardial infarction (STEMI) correlates with its success. The aim of our study was to characterize patients admitted with a diagnosis of STEMI with longer prehospital delay and to analyze its impact on the choice of treatment and on in-hospital prognosis.
We performed a retrospective cohort study of 797 patients consecutively admitted with a diagnosis of STEMI from January 2002 to December 2007. The cutoff for longer pre-hospital delay was defined as three hours. We analyzed demographic, clinical and echocardiographic data and determined the predictors of pre-hospital delay of > or = 3 h.
Of the 797 patients, 77% were male and mean age was 62 +/- 13.64 years. Patients with longer pre-hospital delay were older (p < 0.001), with a higher proportion of female (p = 0.001), hypertensive (p = 0.002), diabetic (p < 0.001), and surgically revascularized patients (p = 0.007), and those with symptom onset between 10 pm and 8 am (p = 0.001). The group with shorter pre-hospital delay included more men (p = 0.001), patients with prior myocardial infarction (p = 0.025) and smokers (p = 0.009). Independent predictors of pre-hospital delay of 3 h included female gender (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.03-2.16), diabetes (OR 1.78, 95% CI 1.23-2.56), systemic arterial hypertension (OR 1.41, 95% CI 1.04-1.93), and symptom onset between 10 pm and 8 am (OR 1.76, 95% CI 1.31-2.38). Independent predictors of pre-hospital delay of > or = 3 h included male gender (OR 0.67, 95% CI 0.46-0.97) and prior myocardial infarction (OR 0.48, 95% CI 0.27-0.84). Reperfusion therapy was performed in 72%, 52% and 12% of patients with pre-hospital delay of 12 h, respectively (p for trend |
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We performed a retrospective cohort study of 797 patients consecutively admitted with a diagnosis of STEMI from January 2002 to December 2007. The cutoff for longer pre-hospital delay was defined as three hours. We analyzed demographic, clinical and echocardiographic data and determined the predictors of pre-hospital delay of > or = 3 h.
Of the 797 patients, 77% were male and mean age was 62 +/- 13.64 years. Patients with longer pre-hospital delay were older (p < 0.001), with a higher proportion of female (p = 0.001), hypertensive (p = 0.002), diabetic (p < 0.001), and surgically revascularized patients (p = 0.007), and those with symptom onset between 10 pm and 8 am (p = 0.001). The group with shorter pre-hospital delay included more men (p = 0.001), patients with prior myocardial infarction (p = 0.025) and smokers (p = 0.009). Independent predictors of pre-hospital delay of 3 h included female gender (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.03-2.16), diabetes (OR 1.78, 95% CI 1.23-2.56), systemic arterial hypertension (OR 1.41, 95% CI 1.04-1.93), and symptom onset between 10 pm and 8 am (OR 1.76, 95% CI 1.31-2.38). Independent predictors of pre-hospital delay of > or = 3 h included male gender (OR 0.67, 95% CI 0.46-0.97) and prior myocardial infarction (OR 0.48, 95% CI 0.27-0.84). Reperfusion therapy was performed in 72%, 52% and 12% of patients with pre-hospital delay of <3 h, 3-12 h and >12 h, respectively (p for trend <0.001). Patients with longer delay more often had severely reduced left ventricular ejection fraction (LVEF) (p = 0.004). A non-significant trend was observed towards increased in-hospital mortality with longer delay (8.3% vs. 6.6%, p for trend = 0.342).
A significant proportion of patients continue to have long pre-hospital delay. Female patients and those with diabetes, systemic arterial hypertension and symptom onset between 10 pm and 8 am made up the majority of this group. Longer pre-hospital delay was associated with a lower probability of being treated with reperfusion therapy, a higher frequency of severely depressed LVEF and a non-significant increase in in-hospital mortality. It is essential to develop mechanisms to reduce pre-hospital delay.</description><identifier>ISSN: 0870-2551</identifier><identifier>PMID: 21265494</identifier><language>eng ; por</language><publisher>Portugal</publisher><subject>Aged ; Cohort Studies ; Female ; Forecasting ; Humans ; Male ; Middle Aged ; Myocardial Infarction - therapy ; Retrospective Studies ; Time Factors</subject><ispartof>Revista portuguesa de cardiologia, 2010-10, Vol.29 (10), p.1521-1532</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21265494$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ribeiro, Sílvia</creatorcontrib><creatorcontrib>Gaspar, Antonio</creatorcontrib><creatorcontrib>Rocha, Sérgia</creatorcontrib><creatorcontrib>Nabais, Sérgio</creatorcontrib><creatorcontrib>Azevedo, Pedro</creatorcontrib><creatorcontrib>Salgado, Alberto</creatorcontrib><creatorcontrib>Pereira, Miguel Alvares</creatorcontrib><creatorcontrib>Correia, Adelino</creatorcontrib><title>Predictors of pre-hospital delay in patients with ST-segment elevation myocardial infarction</title><title>Revista portuguesa de cardiologia</title><addtitle>Rev Port Cardiol</addtitle><description>Early reperfusion therapy in ST-elevation myocardial infarction (STEMI) correlates with its success. The aim of our study was to characterize patients admitted with a diagnosis of STEMI with longer prehospital delay and to analyze its impact on the choice of treatment and on in-hospital prognosis.
We performed a retrospective cohort study of 797 patients consecutively admitted with a diagnosis of STEMI from January 2002 to December 2007. The cutoff for longer pre-hospital delay was defined as three hours. We analyzed demographic, clinical and echocardiographic data and determined the predictors of pre-hospital delay of > or = 3 h.
Of the 797 patients, 77% were male and mean age was 62 +/- 13.64 years. Patients with longer pre-hospital delay were older (p < 0.001), with a higher proportion of female (p = 0.001), hypertensive (p = 0.002), diabetic (p < 0.001), and surgically revascularized patients (p = 0.007), and those with symptom onset between 10 pm and 8 am (p = 0.001). The group with shorter pre-hospital delay included more men (p = 0.001), patients with prior myocardial infarction (p = 0.025) and smokers (p = 0.009). Independent predictors of pre-hospital delay of 3 h included female gender (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.03-2.16), diabetes (OR 1.78, 95% CI 1.23-2.56), systemic arterial hypertension (OR 1.41, 95% CI 1.04-1.93), and symptom onset between 10 pm and 8 am (OR 1.76, 95% CI 1.31-2.38). Independent predictors of pre-hospital delay of > or = 3 h included male gender (OR 0.67, 95% CI 0.46-0.97) and prior myocardial infarction (OR 0.48, 95% CI 0.27-0.84). Reperfusion therapy was performed in 72%, 52% and 12% of patients with pre-hospital delay of <3 h, 3-12 h and >12 h, respectively (p for trend <0.001). Patients with longer delay more often had severely reduced left ventricular ejection fraction (LVEF) (p = 0.004). A non-significant trend was observed towards increased in-hospital mortality with longer delay (8.3% vs. 6.6%, p for trend = 0.342).
A significant proportion of patients continue to have long pre-hospital delay. Female patients and those with diabetes, systemic arterial hypertension and symptom onset between 10 pm and 8 am made up the majority of this group. Longer pre-hospital delay was associated with a lower probability of being treated with reperfusion therapy, a higher frequency of severely depressed LVEF and a non-significant increase in in-hospital mortality. It is essential to develop mechanisms to reduce pre-hospital delay.</description><subject>Aged</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Forecasting</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - therapy</subject><subject>Retrospective Studies</subject><subject>Time Factors</subject><issn>0870-2551</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1UMtKxDAUzUJxhnF-QbJzVUjavLqUwRcMKDjuhHInuXUibVOTVJm_t-J4NgfOa3HOyJIZzYpSSr4g65Q-2AzFeF2pC7IoeamkqMWSvD1HdN7mEBMNLR0jFoeQRp-how47OFI_0BGyxyEn-u3zgb7sioTv_SxQ7PBr9sJA-2OwEJ2fa35oIdpf9ZKct9AlXJ94RV7vbnebh2L7dP-4udkWIxcsFwLR2Fradi8407VG1ADWgnO8RG6FVJyXpXZVZRQ400pjbFtDpfaIioGpVuT6b3eM4XPClJveJ4tdBwOGKTVGaFlrxcScvDolp32Prhmj7yEem_9Dqh-n1F4m</recordid><startdate>201010</startdate><enddate>201010</enddate><creator>Ribeiro, Sílvia</creator><creator>Gaspar, Antonio</creator><creator>Rocha, Sérgia</creator><creator>Nabais, Sérgio</creator><creator>Azevedo, Pedro</creator><creator>Salgado, Alberto</creator><creator>Pereira, Miguel Alvares</creator><creator>Correia, Adelino</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201010</creationdate><title>Predictors of pre-hospital delay in patients with ST-segment elevation myocardial infarction</title><author>Ribeiro, Sílvia ; Gaspar, Antonio ; Rocha, Sérgia ; Nabais, Sérgio ; Azevedo, Pedro ; Salgado, Alberto ; Pereira, Miguel Alvares ; Correia, Adelino</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p140t-4ee8c95cfb410797ee7aaccadd12e1c45611227d3386ad8f588cf9a36bee60a83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng ; por</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Forecasting</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - therapy</topic><topic>Retrospective Studies</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ribeiro, Sílvia</creatorcontrib><creatorcontrib>Gaspar, Antonio</creatorcontrib><creatorcontrib>Rocha, Sérgia</creatorcontrib><creatorcontrib>Nabais, Sérgio</creatorcontrib><creatorcontrib>Azevedo, Pedro</creatorcontrib><creatorcontrib>Salgado, Alberto</creatorcontrib><creatorcontrib>Pereira, Miguel Alvares</creatorcontrib><creatorcontrib>Correia, Adelino</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Revista portuguesa de cardiologia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ribeiro, Sílvia</au><au>Gaspar, Antonio</au><au>Rocha, Sérgia</au><au>Nabais, Sérgio</au><au>Azevedo, Pedro</au><au>Salgado, Alberto</au><au>Pereira, Miguel Alvares</au><au>Correia, Adelino</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of pre-hospital delay in patients with ST-segment elevation myocardial infarction</atitle><jtitle>Revista portuguesa de cardiologia</jtitle><addtitle>Rev Port Cardiol</addtitle><date>2010-10</date><risdate>2010</risdate><volume>29</volume><issue>10</issue><spage>1521</spage><epage>1532</epage><pages>1521-1532</pages><issn>0870-2551</issn><abstract>Early reperfusion therapy in ST-elevation myocardial infarction (STEMI) correlates with its success. The aim of our study was to characterize patients admitted with a diagnosis of STEMI with longer prehospital delay and to analyze its impact on the choice of treatment and on in-hospital prognosis.
We performed a retrospective cohort study of 797 patients consecutively admitted with a diagnosis of STEMI from January 2002 to December 2007. The cutoff for longer pre-hospital delay was defined as three hours. We analyzed demographic, clinical and echocardiographic data and determined the predictors of pre-hospital delay of > or = 3 h.
Of the 797 patients, 77% were male and mean age was 62 +/- 13.64 years. Patients with longer pre-hospital delay were older (p < 0.001), with a higher proportion of female (p = 0.001), hypertensive (p = 0.002), diabetic (p < 0.001), and surgically revascularized patients (p = 0.007), and those with symptom onset between 10 pm and 8 am (p = 0.001). The group with shorter pre-hospital delay included more men (p = 0.001), patients with prior myocardial infarction (p = 0.025) and smokers (p = 0.009). Independent predictors of pre-hospital delay of 3 h included female gender (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.03-2.16), diabetes (OR 1.78, 95% CI 1.23-2.56), systemic arterial hypertension (OR 1.41, 95% CI 1.04-1.93), and symptom onset between 10 pm and 8 am (OR 1.76, 95% CI 1.31-2.38). Independent predictors of pre-hospital delay of > or = 3 h included male gender (OR 0.67, 95% CI 0.46-0.97) and prior myocardial infarction (OR 0.48, 95% CI 0.27-0.84). Reperfusion therapy was performed in 72%, 52% and 12% of patients with pre-hospital delay of <3 h, 3-12 h and >12 h, respectively (p for trend <0.001). Patients with longer delay more often had severely reduced left ventricular ejection fraction (LVEF) (p = 0.004). A non-significant trend was observed towards increased in-hospital mortality with longer delay (8.3% vs. 6.6%, p for trend = 0.342).
A significant proportion of patients continue to have long pre-hospital delay. Female patients and those with diabetes, systemic arterial hypertension and symptom onset between 10 pm and 8 am made up the majority of this group. Longer pre-hospital delay was associated with a lower probability of being treated with reperfusion therapy, a higher frequency of severely depressed LVEF and a non-significant increase in in-hospital mortality. It is essential to develop mechanisms to reduce pre-hospital delay.</abstract><cop>Portugal</cop><pmid>21265494</pmid><tpages>12</tpages></addata></record> |
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| subjects | Aged Cohort Studies Female Forecasting Humans Male Middle Aged Myocardial Infarction - therapy Retrospective Studies Time Factors |
| title | Predictors of pre-hospital delay in patients with ST-segment elevation myocardial infarction |
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