Patient delay in patients with ST-elevation myocardial infarction: Time patterns and predictors for a prolonged delay

To improve treatment success of ST-elevation myocardial infarction, a minimal delay from symptom onset to reperfusion therapy is crucial. The patient’s response to initial symptoms (patient delay) substantially affects the delay. We investigated time patterns of patient delay during a seven-year time period, and aimed to identify key predictors that affect the length of the patient delay.

Data on 5848 patients hospitalized with ST-elevation myocardial infarction and treated with primary percutaneous intervention during the period 2003–2009 were obtained from Danish registry databases. The dependent variable was patient delay (<120 and ⩾120 min). Data were analysed for a possible time trend during the seven-year study period using Jonckheere-Terpstra analysis and we also performed multiple logistical regression to identify predictors of a prolonged patient delay.

We observed a decrease in median patient delay from 101 min in 2003 to 85 min in 2009, p=0.018. We identified the age group 55–69 years (odds ratio (OR): 1.27 (95% confidence interval (CI): 1.09–1.47)) and age ⩾70 years (OR: 1.63 (95% CI: 1.40–1.90)), diabetes (OR: 1.26 (95% CI: 1.05–1.50)), female gender (OR: 1.17 (95% CI: 1.03–1.34)) and presentation during the night 22:00–05:59 (OR: 1.92 (95% CI: 1.68–2.20)), as independent risk factors of a patient delay ⩾120 min. Symptom onset between 14:00–21:59 was associated with a shorter patient delay (OR: 0.78 (95% CI 0.68–0.89)).

A slight decrease in patient delay during the years from 2003–2009 was observed. High age, diabetes, female gender and symptoms presentation during the night were shown to be independent predictors of prolonged patient delay.