Sex and age specific time patterns and long term time trends of pre-hospital delay of patients presenting with acute ST-segment elevation myocardial infarction

Ladwig, Karl-Heinz; Meisinger, Christa; Hymer, Heiko; Wolf, Kathrin; Heier, Margit; von Scheidt, Wolfgang; Kuch, Bernhard

doi:10.1016/j.ijcard.2010.08.003

« Previous Next »International Journal of Cardiology
Volume 152, Issue 3 , Pages 350-355, 3 November 2011

Sex and age specific time patterns and long term time trends of pre-hospital delay of patients presenting with acute ST-segment elevation myocardial infarction

Karl-Heinz Ladwig
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital rechts-der-Isar of the Technical University of Munich, Germany
- Corresponding author. Institute of Epidemiology, Helmholtz National Research Centre for Environmental Health, Post Box 1129, 85764 Neuherberg, Germany. Tel.: +49 89 3187 3623; fax: +49 89 3187 3667.
Christa Meisinger
- I. Med. Klinik, Hospital of Augsburg, Teaching Hospital of the Ludwig-Maximilians-University München, Augsburg, Germany
- Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany
Heiko Hymer
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
Kathrin Wolf
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
Margit Heier
- I. Med. Klinik, Hospital of Augsburg, Teaching Hospital of the Ludwig-Maximilians-University München, Augsburg, Germany
- Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany
Wolfgang von Scheidt
- I. Med. Klinik, Hospital of Augsburg, Teaching Hospital of the Ludwig-Maximilians-University München, Augsburg, Germany
Bernhard Kuch
- I. Med. Klinik, Hospital of Augsburg, Teaching Hospital of the Ludwig-Maximilians-University München, Augsburg, Germany

Received 21 January 2010; received in revised form 6 July 2010; accepted 6 August 2010. published online 03 September 2010.

Abstract

Background

Prompt initiation of treatment after symptom onset of ST-elevation myocardial infarction (STEMI) is a central goal in limiting myocardial damage because of the time-dependent nature of reperfusion therapies. We examined time patterns and long term time trends of pre-hospital delay time (PHDT) of STEMI patients.

Methods

PHDT from 3093 STEMI patients derived from the Augsburg Myocardial Infarction Registry (1985–2004) surviving >24h after admission was obtained by a standardized bedside interview. Patients with in-hospital MI (n=140) and resuscitation (n=157) were excluded. Linear regression models were used to examine monthly median PHDT and individual PHDT over time.

Results

Female sex was associated with longer PHDT (189 (98–542quartiles) min vs. 154 (85–497) min; p<0.0003). Median PHDT in the youngest male subgroup (25–54years) was 128 (73–458) min and mounted to 205 (107–600) min in the oldest female subgroup (65–74years). A minority of 12.4% of patients reached hospital within 1h of delay ranging from 8.7% (in oldest women) to 15.9% (in youngest men).

The age-adjusted linear regression model for monthly PHDT revealed no significant change over 20-year time in both sexes. The corresponding average annual percentage change estimates were −0.45 (95% CI: −1.40 to 0.54) for men and −0.08 (95% CI: −1.80 to 1.67) for women. Emergency ambulance use increased over time, however transportation time remained stable.

Conclusions

PHDT in STEMI patients is constantly high over a 20-year observation period. Room for improvement especially in older women was evidenced. Preventive strategies with focused efforts on this subgroup are warranted.

Keywords: Time trends, Prehospital delay, ST-segment elevation myocardial infarction