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Clinical Outcomes in Patients With Delayed Hospitalization for Non-ST-Segment Elevation Myocardial Infarction

Authors
 Jung-Joon Cha  ;  SungA Bae  ;  Duk-Woo Park  ;  Jae Hyoung Park  ;  Soon Jun Hong  ;  Seong-Mi Park  ;  Cheol Woong Yu  ;  Seung-Woon Rha  ;  Do-Sun Lim  ;  Soon Yong Suh  ;  Seung Hwan Han  ;  Seong-Ill Woo  ;  Nae-Hee Lee  ;  Donghoon Choi  ;  In-Ho Chae  ;  Hyo-Soo Kim  ;  Young Joon Hong  ;  Youngkeun Ahn  ;  Myung Ho Jeong  ;  Tae Hoon Ahn 
Citation
 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol.79(4) : 311-323, 2022-02 
Journal Title
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
ISSN
 0735-1097 
Issue Date
2022-02
MeSH
Aged ; Emergency Medical Services ; Female ; Hospitalization* ; Humans ; Male ; Middle Aged ; Myocardial Revascularization ; Non-ST Elevated Myocardial Infarction / complications ; Non-ST Elevated Myocardial Infarction / mortality* ; Non-ST Elevated Myocardial Infarction / therapy* ; Registries ; Republic of Korea ; Risk Factors ; Survival Rate ; Symptom Assessment ; Time-to-Treatment*
Keywords
NSTEMI ; all-cause mortality ; door-to-catheter time ; prehospital delay ; symptom-to-door time
Abstract
Background: Recently, the number of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) has reduced, whereas increased mortality was reported. A plausible explanation for increased mortality was prehospital delay because of patients' reticence of their symptoms.

Objectives: The purpose of this study was to investigate the association between prehospital delay and clinical outcomes in patients with NSTEMI METHODS: Among 13,104 patients from the Korea-Acute-Myocardial-Infarction-Registry-National Institutes of Health, the authors evaluated 6,544 patients with NSTEMI. Study patients were categorized into 2 groups according to symptom-to-door (StD) time (<24 or ≥24 hours). The primary outcome was 3-year all-cause mortality, and the secondary outcome was 3-year composite of all-cause mortality, recurrent MI, and hospitalization for heart failure.

Results: Overall, 1,827 (27.9%) patients were classified into the StD time ≥24 hours group. The StD time ≥24 hours group had higher all-cause mortality (17.0% vs 10.5%; P < 0.001) and incidence of secondary outcomes (23.3% vs 15.7%; P < 0.001) than the StD time <24 hours group. The higher all-cause mortality in the StD time ≥24 hours group was observed consistently in the subgroup analysis regarding age, sex, atypical chest pain, dyspnea, Q-wave in electrocardiogram, use of emergency medical services, hypertension, diabetes mellitus, chronic kidney disease, left ventricle dysfunction, TIMI (Thrombolysis In Myocardial Infarction) flow, and the GRACE risk score. In the multivariable analysis, independent predictors of prehospital delay were the elderly, women, nonspecific symptoms such as atypical chest pain or dyspnea, diabetes, and no use of emergency medical services.

Conclusions: Prehospital delay is associated with an increased risk of 3-year all-cause mortality in patients with NSTEMI. (iCReaT Study No. C110016).
Full Text
https://www.sciencedirect.com/science/article/pii/S0735109721082085
DOI
10.1016/j.jacc.2021.11.019
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Bae, SungA(배성아) ORCID logo https://orcid.org/0000-0003-1484-4645
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/187986
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