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KMID : 0882420100780060717
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Korean Journal of Medicine
2010 Volume.78 No. 6 p.717 ~ p.724
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Clinical impact of symptom-to-door time on 1-year mortality in patients with non-ST segment elevation acute myocardial infarction
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Lee Sun-Ok
Oh Sang-Eun
Jeong Myung-Ho
Kim Hyun Kuk
Jeon Hae-Jung
Choi Young-Ja
Kim Sung-Soo
Ko Jum-Suk
Lee Min-Goo
Sim Doo-Sun
Park Keun-Ho
Yoon Nam-Sik
Yoon Hyun-Ju
Park Hyung-Wook
Kim Kye-Hun
Hong Young-Joon
Kim Ju-Han
Ahn Young-Keun
Cho Jeong-Gwan
Park Jong-Chun
Kang Jung-Chaee
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Abstract
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Background/Aims: Symptom-to-door time is associated with the prognosis for ST-segment elevation myocardial infarction. However, this value has not been a concern in patients with non-ST segment elevation myocardial infarction (NSTEMI). The aim of this study was to assess the relationship between symptom-to-door time and clinical outcomes in patients with NSTEMI.
Methods: In total, 1,971 patients with NSTEMI (64.8±12.1 years, 23.6% women) were enrolled between Nov. 2005 and Jan. 2008. The patients were divided into two groups according to the time difference between the presentation of symptoms and first medical contact: group I (<12 hours, n=1433) and group II (>12 hours, n=538). One-year mortality rates were compared between the groups. Thrombolysis In Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores were calculated in all study patients.
Results: The mean age was 64.4±12.2 years in group I and 65.6±12.0 years in group II (p=0.046). No significant differences existed between the two groups, except for the prevalence of hypertension, diabetes mellitus, initial systolic blood pressure, and initial serum creatinine levels. One-year mortality rates decreased significantly in group I patients [hazard ratio (HR)=1.35, 95% CI (confidential interval): 1.03~1.75, p=0.028] based on a multivariate Cox proportional analysis, which was adjusted by GRACE score, baseline characteristic variables, and predictors of a 1-year mortality in a univariate analysis. In intermediate-to high-risk patients (n=1,184, defined as having a TIMI risk score above 3 points), significant differences were observed in mortality rates between the two groups (HR=1.35, 95% CI: 1.02~1.80, p=0.037); the low-risk patients (n=787, HR=1.57, 95% CI: 0.80~3.05, p=0.188), however, showed no such differences.
Conclusions: Symptom-to-door time was an independent long-term clinical predictor in patients with NSTEMI, especially in intermediate- to high-risk groups. (Korean J Med 78:717-724, 2010)
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KEYWORD
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Myocardial infarction, Prognosis, Symptoms
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