Factors associated with prolonged prehospital delay in patients with acute myocardial infarction

OBJECTIVES
We investigated factors associated with prolonged prehospital delay in patients with acute myocardial infarction (AMI).

STUDY DESIGN
A total of 439 patients (351 males, 88 females; mean age 57±12 years) with ST-elevation AMI were interviewed within 48 hours of hospitalization. Patients were pain-free and hemodynamically stable at the time of interview. Data were collected on the time from the onset of chest pain to hospital admission and on sociodemographic and clinical characteristics. The patients were evaluated in two groups according to the place to which the first presentation was made, i.e., a local clinic/ small hospital (clinic group: n=209, 47.6%) or our tertiary fully equipped cardiovascular center (hospital group: n=230, 52.4%).

RESULTS
The median and mean delay times were 70 min and 185.2±334.8 min, respectively. Of the study group, 136 patients (31%) arrived within 60 minutes after the onset of symptoms. The median delay time was significantly longer in the clinic group (120 min vs 60 min; p<0.001). Female sex, age ≥55 years, and total education time <9 years were associated with a longer prehospital delay, whereas a history of coronary artery disease (CAD), smoking, and the absence of diabetes were associated with a shorter prehospital delay. In multivariate regression analysis, total education time <9 years, female sex, age ≥55 years, and the absence of previous CAD were independent predictors of prolonged prehospital delay. The incidence of direct hospital presentation significantly increased with older age, smoking, aspirin use, and previous CAD. In multivariate analysis, only previous CAD was an independent predictor of direct hospital presentation.

CONCLUSION
The median delay time of 70 min in this Turkish cohort is in accordance with the data from western populations. Public education campaigns to shorten prehospital delay should place more emphasis on the factors and patient subgroups associated with prolonged prehospital delay.