Prehospital Factors Contributing to Delays in the Timely Management of ST-Elevation Myocardial Infarction

Abstract

Background: Prehospital factors are critical contributors to delays in managing patients with ST elevation myocardial infarction (STEMI), potentially leading to increased mortality and morbidity. Identifying and addressing these obstacles could significantly reduce the mortality and morbidity of these patients and enhance healthcare performance. Objectives: This study aims to evaluate the prehospital factors associated with delays in primary percutaneous coronary intervention (PPCI) among patients with STEMI. Methods: In this prospective study, 394 STEMI patients treated with PPCI were evaluated, with the interval between symptom onset and the start of the procedure being measured and recorded. Patients were categorized into two groups based on this interval: Appropriate and delayed (< 90 minutes vs. ≥ 90 minutes). The potential predictors of delay were identified and assessed. Results: In this study, 394 STEMI patients were evaluated and categorized into 192 patients with delayed PPCI and 202 patients with on-time PPCI. Multivariate analysis revealed that being female (OR: 1.59, 95% CI: 1.08 - 2.01, P-value: < 0.01), having no past medical history of cardiovascular disease (CVD) (OR: 1.49, 95% CI: 1.09 - 1.90, P-value: < 0.01), no family history of CVD (OR: 1.28, 95% CI: 1.04 - 1.53, P-value: 0.03), a lower education level than academic (OR: 1.44, 95% CI: 1.05 - 1.84, P-value: < 0.01), symptom onset between 18:00 and 06:00 (OR: 1.58, 95% CI: 1.10 - 2.06, P-value: 0.01), and transport by ambulance versus private vehicle (OR: 1.57, 95% CI: 1.07 - 2.08, P-value: < 0.01) were significantly associated with a higher risk of delayed PCI. Conversely, higher socioeconomic status (OR: 0.68, 95% CI: 0.51 - 0.86, P-value: 0.02) and having a caregiver at home (OR: 0.52, 95% CI: 0.32 - 0.72, P-value: < 0.01) were significantly associated with a lower risk of delayed PPCI. Conclusions: Reducing factors that contribute to delays in PPCI can lead to improved public health outcomes and greater health opportunities for the population. Delays in STEMI patients were significantly associated with living in rural areas, lower education levels, and female gender. Conversely, using private vehicles for transport, having a caregiver present, and higher socioeconomic status may reduce the risk of delayed PPCI.