BACKGROUND: Prompt initiation of treatment after symptom onset of ST-elevation myocardial infarction (STEMI) is a central goal in limiting myocardial damage because of the time-dependent nature of reperfusion therapies. We examined time patterns and long term time trends of pre-hospital delay time (PHDT) of STEMI patients. METHODS: PHDT from 3093 STEMI patients derived from the Augsburg Myocardial Infarction Registry (1985-2004) surviving >24h after admission was obtained by a standardized bedside interview. Patients with in-hospital MI (n=140) and resuscitation (n=157) were excluded. Linear regression models were used to examine monthly median PHDT and individual PHDT over time. RESULTS: Female sex was associated with longer PHDT (189 (98-542quartiles) min vs. 154 (85-497) min; p<0.0003). Median PHDT in the youngest male subgroup (25-54 years) was 128 (73-458) min and mounted to 205 (107-600) min in the oldest female subgroup (65-74 years). A minority of 12.4% of patients reached hospital within 1h of delay ranging from 8.7% (in oldest women) to 15.9% (in youngest men). The age-adjusted linear regression model for monthly PHDT revealed no significant change over 20-year time in both sexes. The corresponding average annual percentage change estimates were -0.45 (95% CI: -1.40 to 0.54) for men and -0.08 (95% CI: -1.80 to 1.67) for women. Emergency ambulance use increased over time, however transportation time remained stable. CONCLUSIONS: PHDT in STEMI patients is constantly high over a 20-year observation period. Room for improvement especially in older women was evidenced. Preventive strategies with focused efforts on this subgroup are warranted.
BACKGROUND: Prompt initiation of treatment after symptom onset of ST-elevation myocardial infarction (STEMI) is a central goal in limiting myocardial damage because of the time-dependent nature of reperfusion therapies. We examined time patterns and long term time trends of pre-hospital delay time (PHDT) of STEMI patients. METHODS: PHDT from 3093 STEMI patients derived from the Augsburg Myocardial Infarction Registry (1985-2004) surviving >24h after admission was obtained by a standardized bedside interview. Patients with in-hospital MI (n=140) and resuscitation (n=157) were excluded. Linear regression models were used to examine monthly median PHDT and individual PHDT over time. RESULTS: Female sex was associated with longer PHDT (189 (98-542quartiles) min vs. 154 (85-497) min; p<0.0003). Median PHDT in the youngest male subgroup (25-54 years) was 128 (73-458) min and mounted to 205 (107-600) min in the oldest female subgroup (65-74 years). A minority of 12.4% of patients reached hospital within 1h of delay ranging from 8.7% (in oldest women) to 15.9% (in youngest men). The age-adjusted linear regression model for monthly PHDT revealed no significant change over 20-year time in both sexes. The corresponding average annual percentage change estimates were -0.45 (95% CI: -1.40 to 0.54) for men and -0.08 (95% CI: -1.80 to 1.67) for women. Emergency ambulance use increased over time, however transportation time remained stable. CONCLUSIONS: PHDT in STEMI patients is constantly high over a 20-year observation period. Room for improvement especially in older women was evidenced. Preventive strategies with focused efforts on this subgroup are warranted.
Authors: Gregory M Ouellet; Mary Geda; Terrence E Murphy; Sui Tsang; Mary E Tinetti; Sarwat I Chaudhry Journal: J Am Geriatr Soc Date: 2017-10-18 Impact factor: 5.562
Authors: Robert O Roswell; Jordan Kunkes; Anita Y Chen; Karen Chiswell; Sohah Iqbal; Matthew T Roe; Sripal Bangalore Journal: J Am Heart Assoc Date: 2017-01-11 Impact factor: 5.501
Authors: Khalid F AlHabib; Kadhim Sulaiman; Jassim Al Suwaidi; Wael Almahmeed; Alawi A Alsheikh-Ali; Haitham Amin; Mohammed Al Jarallah; Hussam F Alfaleh; Prashanth Panduranga; Ahmad Hersi; Tarek Kashour; Zohair Al Aseri; Anhar Ullah; Hani B Altaradi; Kazi Nur Asfina; Robert C Welsh; Salim Yusuf Journal: PLoS One Date: 2016-01-25 Impact factor: 3.240
Authors: Sofia Sederholm Lawesson; Rose-Marie Isaksson; Maria Ericsson; Karin Ängerud; Ingela Thylén Journal: BMJ Open Date: 2018-05-03 Impact factor: 2.692