1887
Volume 2016, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Early treatment of ST elevation myocardial infarction (STEMI) is essential to improve survival of these patients. However, not all patients present early enough to receive optimal treatment especially in third world countries. Social factors affecting early vs. late treatment have not been studied, particularly in the Middle East. Thus, the aim of this study was to determine the social factors associated with delayed presentation of STEMI patients. All patients with STEMI presenting to King Abdulaziz Cardiac Center (KACC) between October 2013 and July 2014 were approached. After obtaining consent, patients were interviewed regarding their psychosocial circumstances using a standardized questionnaire. Their medical charts were also reviewed for further clinical data. Patients were divided according to their symptom-to-door time into early ( ≤ 6h) and late (>6h) presentation and group comparisons were conducted. A total of 79 patients were enrolled, of which 24 patients (30%) presented late. Patients with increased symptom-to-door time had higher prevalence of diabetes (40% vs. 79.2%, p = 0.001), hypertension (43.6% vs. 70.8%, p = 0.023), and dyslipidemia (23.6% vs. 54.2%, p = 0.009). Most of the late presenters did not undergo primary coronary intervention (72.7% vs. 47.8%, P = 0.034) and had less prior information about myocardial infarction (43.6% vs. 25%, P = 0.023). Late presenters were more often illiterates and lived most often far away from the hospital. Using multivariate logistic regression; dyslipidemia was the only independent predictor for the late hospital presentation for STEMI patients. One third of patients with STEMI present more than six hours after symptom onset; these patients have a higher prevalence of coronary risk factors and less information about STEMI. Programs should be designed to educate patients and the general public about the symptoms of STEMI and the necessary action to be taken if a heart attack is suspected.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2016.7
2016-07-26
2024-03-28
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2016/1/qmj.2016.7.html?itemId=/content/journals/10.5339/qmj.2016.7&mimeType=html&fmt=ahah

References

  1. Angerud KH, Brulin C, Naslund U, Eliasson M. Longer pre-hospital delay in first myocardial infarction among patients with diabetes: an analysis of 4266 patients in the northern Sweden MONICA Study. BMC Cardiovasc Disord. 2013; 13::6.
    [Google Scholar]
  2. Foraker RE, Rose KM, McGinn AP, Suchindran CM, Goff DC Jr, Whitsel EA, Wood JL, Rosamond WD. Neighborhood income, health insurance, and prehospital delay for myocardial infarction: The atherosclerosis risk in communities study. Arch Intern Med. 2008; 168::18741879.
    [Google Scholar]
  3. Boersma E, Maas AC, Deckers JW, Simoons ML. Early thrombolytic treatment in acute myocardial infarction: Reappraisal of the golden hour. Lancet. 1996; 348:9030:771775.
    [Google Scholar]
  4. Shavadia J, Zheng Y, Dianati Maleki N, Huber K, Halvorsen S, Goldstein P, Gershlick AH, Wilcox R, Van de Werf F, Armstrong PW. Infarct size, shock, and heart failure: Does reperfusion strategy matter in early presenting patients with ST-segment elevation myocardial infarction? J Am Heart Assoc. 2015; 4:8:e002049.
    [Google Scholar]
  5. Rentrop KP, Feit F. Reperfusion therapy for acute myocardial infarction: Concepts and controversies from inception to acceptance. Am Heart J. 2015; 170:5:971980.
    [Google Scholar]
  6. McKee G, Mooney M, O'Donnell S, O'Brien F, Biddle MJ, Moser DK. Multivariate analysis of predictors of pre-hospital delay in acute coronary syndrome. Int J Cardiol. 2013; 168::27062713.
    [Google Scholar]
  7. Nallamothu B, Fox KA, Kennelly BM, VandeWerf F, Gore JM, Steg PG, Granger CB, Dabbous OH, Kline-Rogers E, Eagle KA, GRACE Investigators . Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events. Heart. 2007; 93:12:15521555.
    [Google Scholar]
  8. Nguyen HL, Saczynski JS, Gore JM, Goldberg RJ. Age and sex differences in duration of prehospital delay in patients with acute myocardial infarction: A systematic review. Circ Cardiovasc Qual Outcomes. 2010; 3::8292.
    [Google Scholar]
  9. Ting HH, Bradley EH, Wang Y, Nallamothu BK, Gersh BJ, Roger VL, Lichtman JH, Curtis JP, Krumholz HM. Delay in presentation and reperfusion therapy in ST-elevation myocardial infarction. Am J Med. 2008; 121::316323.
    [Google Scholar]
  10. Al-Mallah MH, Alsheikh-Ali AA, Almahmeed W, Sulaiman K, Al Suwaidi J, Ridha M, Al-Motarreb A, Alenezi F, Zubaid M. Missed opportunities in the management of ST-segment elevation myocardial infarction in the Arab Middle East: Patient and physician impediments. Clin Cardiol. 2010; 33::565571.
    [Google Scholar]
  11. O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines . 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 127:4:e362e425.
    [Google Scholar]
  12. Sheifer SE, Rathore SS, Gersh BJ, Weinfurt KP, Oetgen WJ, Breall JA, Schulman KA. Time to presentation with acute myocardial infarction in the elderly: Associations with race, sex, and socioeconomic characteristics. Circulation. 2000; 102:14:16511656.
    [Google Scholar]
  13. Malmberg K, Ryden L. Myocardial infarction in patients with diabetes mellitus. Eur Heart J. 1988; 9:3:259264.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2016.7
Loading
/content/journals/10.5339/qmj.2016.7
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): late presentation myocardial infarction; third world countriessocial factors and STEMI
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error