Dataset Information

Association of pre-hospital time intervals and clinical outcomes in ST-elevation myocardial infarction patients.

ABSTRACT:

Study objectives

Timely coronary reperfusion is critical for favorable outcomes after ST-elevation myocardial infarction (STEMI). A substantial proportion of the total ischemic time is patient related, occurring before first medical contact (FMC). We aimed to expand the limited current understanding of the associations between prehospital intervals and clinical outcomes.

Methods

We conducted a retrospective analysis of consecutive STEMI patients who underwent primary percutaneous coronary intervention (pPCI) (January 2009-March 2016) and assessed the associations between prehospital intervals and the incidence of new heart failure, cardiogenic shock, and hospital length of stay (LOS), adjusting for important clinical variables.

Results

A total of 773 patients (77% men, median age 65 years) met eligibility criteria. The median pre-911 activation interval was 29 minutes (interquartile range: 11, 89); the median 911 call to FMC interval was 12 minutes (interquartile range: 9, 15). In multivariable analysis, there was a V-shaped relationship between the pre-911 activation interval and outcomes: a lower likelihood of new heart failure (odds ratio [OR] 0.51; 95% confidence interval [CI]: 0.30, 0.87), cardiogenic shock (OR 0.40; 95% CI: 0.21, 0.75) and prolonged LOS (OR 0.24; 95% CI: 0.14, 0.42) for midrange intervals (11-88 minutes) when compared to the early (< 11-minute) interval. There was no statistically significant relationship between total pre-FMC time and FMC to device activation time.

Conclusions

Among ambulance-transported STEMI patients receiving pPCI, the shortest and longest pre-911 activation time intervals were associated with poorer outcomes. However, variation in post-FMC interval alone was not associated with outcomes, suggesting that interventions to reduce pre-FMC intervals must be prioritized.

SUBMITTER: Mackay MH

PROVIDER: S-EPMC9174874 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Association of pre-hospital time intervals and clinical outcomes in ST-elevation myocardial infarction patients.

Mackay Martha H MH Chruscicki Adam A Christenson Jim J Cairns John A JA Lee Terry T Turgeon Ricky R Tallon John M JM Helmer Jennifer J Singer Joel J Wong Graham C GC Fordyce Christopher B CB

Journal of the American College of Emergency Physicians open 20220608 3

<h4>Study objectives</h4>Timely coronary reperfusion is critical for favorable outcomes after ST-elevation myocardial infarction (STEMI). A substantial proportion of the total ischemic time is patient related, occurring before first medical contact (FMC). We aimed to expand the limited current understanding of the associations between prehospital intervals and clinical outcomes.<h4>Methods</h4>We conducted a retrospective analysis of consecutive STEMI patients who underwent primary percutaneous ...[more]

PMID: 35702143

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Project description:BackgroundPre-hospital delay is currently a major factor limiting early reperfusion among ST-elevation myocardial infarction (STEMI) patients worldwide. This study aims to determine pre-hospital factors affecting symptom-to-door time among STEMI patients in Malaysia.MethodsThis cross-sectional study included 222 STEMI patients admitted to two tertiary hospitals in Malaysia. By determining symptom-to-door time, the study population was categorised into two definitive treatment seeking groups: early (≤ 3 h) and delayed (> 3 h). Data was collected focusing on socio-demographical data, risk factors and comorbidities, clinical presentation, situational factors and action taken by patients.ResultsThe mean age of our patients was 58.0 (SD = 11.9) years old, and the population consisted of 186 (83.8%) males and 36 (16.2%) females. Our study found that the median symptom-to-door time was 130.5 (IQR 240) min, with 64% of subjects arriving early and 36% arriving late. Pre-hospital delays were found to be significant among females (adj OR = 2.42; 95% CI: 1.02, 5.76; P = 0.046), patients with recurrence of similar clinical presentations (adj OR = 2.74; 95% CI: 1.37, 5.46; P = 0.004), patients experiencing atypical symptoms (adj OR = 2.64; 95% CI: 1.11, 6.31; P = 0.029) and patients who chose to have their first medical contact (FMC) for their symptoms with a general practitioner (adj OR = 2.80; 95% CI: 1.20, 6.56; P = 0.018). However, patients with hyperlipidaemia (adj OR = 0.46; 95% CI: 0.23, 0.93; P = 0.030), self-perceived cardiac symptoms (adj OR = 0.36; 95% CI: 0.17, 0.73; P = 0.005) and symptoms that began in public places (adj OR = 0.21; 95% CI: 0.06, 0.69; P = 0.010) tended to seek treatment earlier.ConclusionThe symptom-to-door time among the Malaysian population is shorter in comparison to other developing countries. Nevertheless, identified, modifiable pre-hospital factors can be addressed to further shorten symptom-to-door time among STEMI patients.

Dataset Information

Association of pre-hospital time intervals and clinical outcomes in ST-elevation myocardial infarction patients.

Study objectives

Methods

Results

Conclusions

Publications

Association of pre-hospital time intervals and clinical outcomes in ST-elevation myocardial infarction patients.

Similar Datasets

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