TY - JOUR
T1 - Symptom-to-door delay among patients with ST-segment elevation myocardial infarction in Singapore
AU - Wah, Win
AU - Pek, Pin Pin
AU - Ho, Andrew Fu Wah
AU - Fook-Chong, Stephanie
AU - Zheng, Huili
AU - Loy, En Yun
AU - Chua, Terrance Siang Jin
AU - Koh, Tian Hai
AU - Chow, Khuan Yew
AU - Earnest, Arul
AU - Pang, Junxiong
AU - Ong, Marcus Eng Hock
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Objectives: Symptom-to-door time (S2D) is one of the important components of ischaemic time, which might affect the infarct size and outcomes of acute myocardial infarction. The aim of the present study was to identify patients’ characteristics associated with delayed symptom-onset-to-arrival at EDs in ST-segment elevation myocardial infarction (STEMI) patients in Singapore. Methods: Retrospective data of STEMI patients presenting to the ED of all public hospitals with onsite primary percutaneous coronary intervention facilities between 2010 and 2012 were obtained from the Singapore Myocardial Infarction Registry. Based on the S2D of 120 min, characteristics of patients were compared between short S2D (≤120 min) and long S2D (>120 min). Multivariate logistic and linear regression analyses were performed. Results: Out of 3848 patients, 1682 patients had an S2D of ≤120 min, and 2166 had an S2D >120 min. In the multivariate analyses, older age, Malay ethnicity, diabetes mellitus, presenting symptoms of back and epigastric pain were independently associated with long S2D. Patients who utilised the emergency medical services, presented after office hours and with symptoms of chest pain, breathlessness, diaphoresis and past history of percutaneous transluminal coronary angioplasty/primary percutaneous coronary intervention, were independently associated with short S2D. Patients with long S2D had lower probability of receiving reperfusion treatment with delayed symptom-to-balloon and door-to-balloon time and higher probabilities of complications and mortality. Conclusion: The present study shows that longer S2D was associated with older age, ethnicity, diabetes mellitus, delay in receiving early reperfusion treatment and poorer prognosis.
AB - Objectives: Symptom-to-door time (S2D) is one of the important components of ischaemic time, which might affect the infarct size and outcomes of acute myocardial infarction. The aim of the present study was to identify patients’ characteristics associated with delayed symptom-onset-to-arrival at EDs in ST-segment elevation myocardial infarction (STEMI) patients in Singapore. Methods: Retrospective data of STEMI patients presenting to the ED of all public hospitals with onsite primary percutaneous coronary intervention facilities between 2010 and 2012 were obtained from the Singapore Myocardial Infarction Registry. Based on the S2D of 120 min, characteristics of patients were compared between short S2D (≤120 min) and long S2D (>120 min). Multivariate logistic and linear regression analyses were performed. Results: Out of 3848 patients, 1682 patients had an S2D of ≤120 min, and 2166 had an S2D >120 min. In the multivariate analyses, older age, Malay ethnicity, diabetes mellitus, presenting symptoms of back and epigastric pain were independently associated with long S2D. Patients who utilised the emergency medical services, presented after office hours and with symptoms of chest pain, breathlessness, diaphoresis and past history of percutaneous transluminal coronary angioplasty/primary percutaneous coronary intervention, were independently associated with short S2D. Patients with long S2D had lower probability of receiving reperfusion treatment with delayed symptom-to-balloon and door-to-balloon time and higher probabilities of complications and mortality. Conclusion: The present study shows that longer S2D was associated with older age, ethnicity, diabetes mellitus, delay in receiving early reperfusion treatment and poorer prognosis.
KW - epidemiology
KW - mortality
KW - myocardial infarction
KW - prehospital emergency care
UR - http://www.scopus.com/inward/record.url?scp=84995977074&partnerID=8YFLogxK
U2 - 10.1111/1742-6723.12689
DO - 10.1111/1742-6723.12689
M3 - Article
AN - SCOPUS:84995977074
SN - 1742-6731
VL - 29
SP - 24
EP - 32
JO - EMA - Emergency Medicine Australasia
JF - EMA - Emergency Medicine Australasia
IS - 1
ER -