Factors Related to Pre-hospital Delay in Korean Patients with ST-segment Elevation Myocardial Infarction: A Data from the Province of Jeonbuk Regional Cardiovascular Center

Mi Rim Lee; Kyeong Ho Yun; Dong Hyun Kim; Sangwoo Kang; Young Jun Kim; Sun Ho Woo; Young Hoon Jeong; Yong Cheol Kim; Young-Hoon Lee; Jeong Mi Lee; Jum Suk Ko; Sang Jae Rhee; Nam-Ho Kim; Seok Kyu Oh

doi:10.12997/jla.2016.5.1.21

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Lee, Yun, Kim, Kang, Kim, Woo, Jeong, Kim, Lee, Lee, Ko, Rhee, Kim, and Oh: Factors Related to Pre-hospital Delay in Korean Patients with ST-segment Elevation Myocardial Infarction: A Data from the Province of Jeonbuk Regional Cardiovascular Center

Original Article

Journal of Lipid and Atherosclerosis 2016; 5(1): 21-26.

Published online: 30 June 2016

DOI: https://doi.org/10.12997/jla.2016.5.1.21

Factors Related to Pre-hospital Delay in Korean Patients with ST-segment Elevation Myocardial Infarction: A Data from the Province of Jeonbuk Regional Cardiovascular Center

Mi Rim Lee¹, Kyeong Ho Yun^1,², Dong Hyun Kim², Sangwoo Kang², Young Jun Kim², Sun Ho Woo², Young Hoon Jeong², Yong Cheol Kim², Young-Hoon Lee¹, Jeong Mi Lee³, Jum Suk Ko^1,², Sang Jae Rhee^1,², Nam-Ho Kim^1,², Seok Kyu Oh^1,²

¹Regional Cardiovascular Center, Wonkwang University Hospital, Iksan, Korea.

²Department of Cardiovascular Medicine, Wonkwang University Hospital, Iksan, Korea.

³Department of Public Health, Wonkwang University School of Medicine, Iksan, Korea.

Corresponding Author: Kyeong Ho Yun. Department of Cardiovascular Medicine, Regional Cardiovascular Center, Wonkwang University Hospital, 895 Muwang-ro, Iksan 570-711, Korea. Tel: +82-63-859-2524, Fax: +82-63-852-8480, dryunkh@gmail.com

Received 2 July 2015 Revised 13 August 2015 Accepted 2 September 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Despite successful efforts to shorten the door-to-balloon time in patients with ST-segment elevation myocardial infarction (STEMI), pre-hospital delayremains a problem. We evaluated the factors related to pre-hospital delay using the Jeonbuk regional cardiovascular center database.

Methods

From 2010 to 2013, a total of 384 STEMI patients were enrolled. We analyzed the onset time, door time, and balloon time, and the patients were grouped according to pre-hospital delay (120 minutes). Clinical and socio-demographic variables were compared.

Results

53.2% of patients had prolonged onset-to-door time (median 130, interquartile range [IQR] 66~242 minutes), and 68.5% of patients did not achieve <120 minute of total ischemic time (median 175, IQR 110~304 minutes). Pre-hospital delay was more frequent in patients with old age, female, no local residence, low education level, transfer via other hospital and no use of emergency squad (119). Only 20% of patients used 119, and 119 team responded in a prompt manner (call to scene time 6 min), but 41.6% of patients was transported to non-PCI-capable hospitals. Multivariate analysis revealed that transfer via other hospital [Odds ratio (OR) 2.5, 95% confidence interval (CI) 1.6-4.1, p<0.001), use of 119 (OR 0.4, 95% CI 0.2-0.6, p<0.001), age >60 years (OR 1.8, 95% CI 1.1-3.0, p=0.031) and hypertension (OR 1.9, 95% CI 1.2-2.9, p=0.047) were independent predictors of pre-hospital delay.

Conclusions

The present study demonstrated a significant pre-hospital delay in the treatment of STEMI patients in the Province of Jeonbuk. Public campaigns and education are needed to raise the public awareness of STEMI and the use of 119.

Keywords: Myocardial infarction, Time-to-Treatment, Emergency medical services

Figures and Tables

Fig. 1

Components of time delay in patients with ST-segment elevation myocardial infarction.

Table 1

Baseline clinical and angiographic characteristics according to pre-hospital delay

	Total	≤120 min (n=180)	>120 min (n=204)	p value
Age (years)	64.2±13.2	61.7±13.1	66.5±13.0	<0.001
Male (%)	289 (75.3)	148 (82.2)	141 (69.1)	0.003
Hypertension (%)	192 (50.0)	75 (41.7)	117 (57.4)	<0.001
Diabetes (%)	76 (19.8)	30 (16.7)	47 (23.0)	0.127
Current smoker (%)	144 (37.5)	71 (39.4)	73 (35.8)	0.462
Previous PCI (%)	33 (8.6)	21 (11.7)	12 (5.9)	0.047
Dyslipidemia (%)	39 (10.2)	21 (11.7)	18 (8.8)	0.399
Anterior myocardial infarction (%)	173 (45.1)	78 (43.3)	95 (46.6)	0.539
Killip class ≥2 (%)	120 (31.3)	61 (33.9)	59 (28.9)	0.321
Onset-to-door time (min)	229.8±286.7	65.3±29.61	374.9±330.31	<0.001
Door-to-balloon time (min)	85.9±522.9	64.0±127.74	105.2±708.03	0.448

Values are presented as mean±standard deviation or number (%).

PCI; percutaneous coronary intervention

Table 2

Socio-demographic characteristics according to pre-hospital delay

	≤120 min (n=180)	>120 min (n=204)	p value
Residency (%)			0.004
Iksan city	90 (50.0)	72 (35.3)
Others	90 (50.0)	132 (64.7)
Education ≤high school (%)	82 (45.6)	126 (61.8)	0.002
Night onset (6 p.m.–6 a.m.) (%)	65 (36.1)	74 (36.3)	1.00
Holiday onset (%)	45 (25.0)	45 (22.1)	0.656
Not-married (%)	30 (16.7)	37 (18.1)	0.788
Via referral hospital (%)	80 (44.4)	147 (72.1)	<0.001
Use of 119 (%)	52 (28.9)	25 (12.3)	<0.001
Private transport (%)	59 (32.8)	72 (35.3)	0.666

Table 3

Status of 119 responses

Variables	Results
Patients called 119 (%)	77 (20.1)
Onset to 119 call time (min)	34 [9, 113]
Call to scene time* (min)	6 [4, 11]
119 call to door time (min)	42 [26, 72]
Non PCI center transport (%)	32 (41.6)
Transport time of direct transport cases (min)	28 [24, 42]
Transport time of referral center visit cases (min)	72 [56, 94]

Continuous variables are presented as median [interquartile range].

Call to scene time indicated interval from the time at the patient called emergency squad (119) to the time at 119 rescuers arrives at the patient's side.

Table 4

Multivariate analysis for the prediction of pre-hospital delay

	univariate			multivariate
	OR	95% CI	p	OR	95% CI	p
Via referral hospital	3.2	2.1-4.8	<0.001	2.5	1.6-4.1	<0.001
Use of 119	0.4	0.2-0.6	<0.001	0.4	0.2-0.6	<0.001
Age >60 years	2.1	1.4-3.2	<0.001	1.8	1.1-3.0	0.031
Hypertension	1.9	1.3-2.8	0.002	1.9	1.2-2.9	0.047
Male gender	0.5	0.3-0.8	0.003	0.8	0.4-1.4	0.395
Previous PCI	0.5	0.2-1.0	0.047	0.5	0.2-1.2	0.121
Residency (Iksan city)	0.5	0.4-0.8	0.004	0.8	0.5-1.3	0.395
Education (≤ high school)	0.5	0.3-0.8	0.002	0.7	0.4-1.2	0.167

PCI; percutaneous coronary intervention.

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