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KMID : 0338420200350010119
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Korean Journal of Internal Medicine
2020 Volume.35 No. 1 p.119 ~ p.132
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Pre-hospital delay and emergency medical services in acute myocardial infarction
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Lee Seung-Hun
Kim Hyun-Kuk
Jeong Myung-Ho
Lee Joo-Myung
Gwon Hyeon-Cheol
Chae Shung-Chull
Seong In-Whan
Park Jong-Seon
Chae Jei-Keon
Hur Seung-Ho
Cha Kwang-Soo
Kim Hyo-Soo
Seung Ki-Bae
Rha Seung-Woon
Ahn Tae-Hoon
Kim Chong-Jin
Hwang Jin-Yong
Choi Dong-Ju
Yoon Jung-Han
Joo Seung-Jae
Hwang Kyung-Kuk
Kim Doo-Il
Oh Seok-Kyu
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Abstract
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Background/Aims: Minimising total ischemic time (TIT) is important for improving clinical outcomes in patients with ST-segment elevation myocardial infarction who have undergone percutaneous coronary intervention (PCI). TIT has not shown a significant improvement due to persistent pre-hospital delay. This study aimed to investigate the risk factors associated with pre-hospital delay.
Methods: Individuals enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health between 2011 and 2015 were included in this study. The study population was analyzed according to the symptom-to-door time (STDT; within 60 or > 60 minutes), and according to the type of hospital visit (emergency medical services [EMS], non-PCI center, or PCI center).
Results: A total of 4,874 patients were included in the analysis, of whom 28.4% arrived at the hospital within 60 minutes of symptom-onset. Old age (> 65 years), female gender, and renewed ischemia were independent predictors of delayed STDT. Utilising EMS was the only factor shown to reduce STDT within 60 minutes, even when cardiogenic shock was evident. The overall frequency of EMS utilisation was low (21.7%). Female gender was associated with not utilising EMS, whereas cardiogenic shock, previous myocardial infarction, familial history of ischemic heart disease, and off-hour visits were associated with utilising EMS.
Conclusions: Factors associated with delayed STDT and not utilising EMS could be targets for preventive intervention to improve STDT and TIT.
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KEYWORD
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Time factors , Emergency medical services , Myocardial infarction , Cardiogenic shock , Prognosis
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