Pre-hospital delay and emergency medical services in acute myocardial infarction

KAMIR Investigators

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)119-132
Number of pages14
JournalKorean Journal of Internal Medicine
Volume35
Issue number1
DOIs
Publication statusPublished - 2020 Jan 1

Fingerprint

Emergency Medical Services
Myocardial Infarction
Cardiogenic Shock
Percutaneous Coronary Intervention
National Institutes of Health (U.S.)
Korea
Myocardial Ischemia
Registries
Ischemia
Population

Keywords

  • Cardiogenic shock
  • Emergency medical services
  • Myocardial infarction
  • Prognosis
  • Time factors

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Pre-hospital delay and emergency medical services in acute myocardial infarction. / KAMIR Investigators.

In: Korean Journal of Internal Medicine, Vol. 35, No. 1, 01.01.2020, p. 119-132.

Research output: Contribution to journalArticle

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abstract = "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.",
keywords = "Cardiogenic shock, Emergency medical services, Myocardial infarction, Prognosis, Time factors",
author = "{KAMIR Investigators} and Lee, {Seung Hun} and Kim, {Hyun Kuk} and Jeong, {Myung Ho} and Lee, {Joo Myung} and Gwon, {Hyeon Cheol} and Chae, {Shung Chull} and Seong, {In Whan} and Park, {Jong Seon} and Chae, {Jei Keon} and Hur, {Seung Ho} and Cha, {Kwang Soo} and Kim, {Hyo Soo} and Seung, {Ki Bae} and Rha, {Seung Woon} and Ahn, {Tae Hoon} and Kim, {Chong Jin} and Hwang, {Jin Yong} and Choi, {Dong Ju} and Junghan Yoon and Joo, {Seung Jae} and Hwang, {Kyung Kuk} and Kim, {Doo Il} and Oh, {Seok Kyu}",
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T1 - Pre-hospital delay and emergency medical services in acute myocardial infarction

AU - KAMIR Investigators

AU - Lee, Seung Hun

AU - Kim, Hyun Kuk

AU - Jeong, Myung Ho

AU - Lee, Joo Myung

AU - Gwon, Hyeon Cheol

AU - Chae, Shung Chull

AU - Seong, In Whan

AU - Park, Jong Seon

AU - Chae, Jei Keon

AU - Hur, Seung Ho

AU - Cha, Kwang Soo

AU - Kim, Hyo Soo

AU - Seung, Ki Bae

AU - Rha, Seung Woon

AU - Ahn, Tae Hoon

AU - Kim, Chong Jin

AU - Hwang, Jin Yong

AU - Choi, Dong Ju

AU - Yoon, Junghan

AU - Joo, Seung Jae

AU - Hwang, Kyung Kuk

AU - Kim, Doo Il

AU - Oh, Seok Kyu

PY - 2020/1/1

Y1 - 2020/1/1

N2 - 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.

AB - 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.

KW - Cardiogenic shock

KW - Emergency medical services

KW - Myocardial infarction

KW - Prognosis

KW - Time factors

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