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Patient characteristics associated with self-presentation, treatment delay and survival following primary percutaneous coronary intervention

Lookup NU author(s): Dr David Austin, Dr Vijay Kunadian, Dr Richard Edwards, Dr Mohaned Egred, Dr Alan Bagnall

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Abstract

Delayed arrival to a primary percutaneous coronary intervention (PPCI)-capable hospital following ST-elevation myocardial infarction (STEMI) is associated with poorer outcome. The influence of patient characteristics on delayed presentation during STEMI is unknown. This was a retrospective observational study. Patients presenting for PPCI from March 2008 to November 2011 in the north of England (Northumbria, Tyne and Wear) were included. The outcomes were self-presentation to a non-PPCI-capable hospital, symptom to first medical contact (STFMC) time, total ischaemic time and mortality during follow-up. STEMI patients included numbered 2297; 619 (26.9%) patients self-presented to a non-PPCI-capable hospital. STFMC of >30 min and total ischaemic time of >180 min was present in 1521 (70.7%) and 999 (44.9%) cases, respectively. Self-presentation was the strongest predictor of prolonged total ischaemic time (odds ratio, OR (95% confidence interval, CI): 5.05 (3.99–6.39)). Married patients (OR 1.38 (1.10–1.74)) and patients living closest to an Emergency Room self-presented more commonly (driving time (vs. ≤10 min) 11–20 min OR 0.66 (0.52–0.83), >20 minutes OR 0.46 (0.33–0.64). Unmarried females waited longest to call for help (OR vs. married males 1.89 (1.29–2.78) and experienced longer total ischaemic times (OR 1.51 (1.10–2.07)). Married patients had a borderline association with lower mortality (hazard ratio 0.75 (0.53–1.05), p=0.09). Unmarried female patients had the longest treatment delays. Married patients and those living closer to an Emergency Room self-present more frequently. Early and exclusive use of the ambulance service may reduce treatment delay and improve STEMI outcome. © 2014, The European Society of Cardiology. All rights reserved.


Publication metadata

Author(s): Austin D, Yan AT, Spratt JC, Kunadian V, Edwards RJ, Egred M, Bagnall AJ

Publication type: Article

Publication status: Published

Journal: European Heart Journal: Acute Cardiovascular Care

Year: 2014

Volume: 3

Issue: 3

Pages: 214-222

Print publication date: 01/09/2014

Online publication date: 11/03/2014

Acceptance date: 17/02/2014

ISSN (print): 2048-8726

ISSN (electronic): 2048-8734

Publisher: Sage Publications Ltd

URL: https://doi.org/10.1177/2048872614527011

DOI: 10.1177/2048872614527011

PubMed id: 24619818


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