Patient delay in patients with ST-elevation myocardial infarction: Time patterns and predictors for a prolonged delay

Abstract

Background and aims: To improve treatment success of ST-elevation myocardial infarction, a minimal delay from symptom onset to reperfusion therapy is crucial. The patient's response to initial symptoms (patient delay) substantially affects the delay. We investigated time patterns of patient delay during a seven-year time period, and aimed to identify key predictors that affect the length of the patient delay.

Methods: Data on 5848 patients hospitalized with ST-elevation myocardial infarction and treated with primary percutaneous intervention during the period 2003-2009 were obtained from Danish registry databases. The dependent variable was patient delay (<120 and ⩾120 min). Data were analysed for a possible time trend during the seven-year study period using Jonckheere-Terpstra analysis and we also performed multiple logistical regression to identify predictors of a prolonged patient delay.

Results: We observed a decrease in median patient delay from 101 min in 2003 to 85 min in 2009, p=0.018. We identified the age group 55-69 years (odds ratio (OR): 1.27 (95% confidence interval (CI): 1.09-1.47)) and age ⩾70 years (OR: 1.63 (95% CI: 1.40-1.90)), diabetes (OR: 1.26 (95% CI: 1.05-1.50)), female gender (OR: 1.17 (95% CI: 1.03-1.34)) and presentation during the night 22:00-05:59 (OR: 1.92 (95% CI: 1.68-2.20)), as independent risk factors of a patient delay ⩾120 min. Symptom onset between 14:00-21:59 was associated with a shorter patient delay (OR: 0.78 (95% CI 0.68-0.89)).

Conclusion: A slight decrease in patient delay during the years from 2003-2009 was observed. High age, diabetes, female gender and symptoms presentation during the night were shown to be independent predictors of prolonged patient delay.

Keywords: Patient delay; acute coronary syndrome; health care organization; primary percutaneous coronary intervention.