Delay from symptom onset to hospital presentation for patients with non- ST-segment elevation myocardial infarction

Henry H. Ting, Anita Y. Chen, Matthew T. Roe, Paul S. Chan, John A. Spertus, Brahmajee K. Nallamothu, Mark D. Sullivan, Elizabeth R. DeLong, Elizabeth H. Bradley, Harlan M. Krumholz, Eric D. Peterson

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Abstract

Background: Secular trends and factors associated with delay time from symptom onset to hospital presentation are known for patients with ST-segment elevation myocardial infarction (STEMI) but are less well-described for non-STEMI. Methods: We studied 104 622 patients with non-STEMI enrolled at 568 hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) National Quality Improvement Initiative from January 1, 2001, to December 31, 2006. We examined secular trends and factors associated with delay time and the association of delay time with in-hospital mortality. Results: Median delay time from symptom onset to hospital presentation was 2.6 hours (interquartile range, 1.3-6.0) and has been stable from 2001 to 2006 (P value for trend, .16). After multivariable adjustment, factors associated with longer delay time included older age, female sex, nonwhite race, diabetes, and current smoking. In addition, compared with those who presented during weekday daytime (>8 AM to 4 PM), patients who presented during weekday and weekend nights (>12 AM to 8 AM) had a 24.7% and 24.3% shorter delay time, respectively (P<.001). After multivariable adjustment, the odds ratio of in-hospital mortality for patients with delay times of 0 to 1 hour or less, more than 1 to 2 hours, more than 2 to 3 hours, and more than 3 to 6 hours compared with the reference group (delay time >6 hours) were 1.19 (95% confidence interval [CI], 1.08-1.30), 0.91 (95% CI, 0.83-1.00), 0.77 (95% CI, 0.69-0.88), and 0.90 (95% CI, 0.81-1.00), respectively. Conclusions: Long delay times are common and have not changed over time for patients with non-STEMI. Because patients cannot differentiate whether symptoms are due to STEMI or non-STEMI, early presentation is desirable in both instances.

Original languageEnglish (US)
Pages (from-to)1834-1841
Number of pages8
JournalArchives of Internal Medicine
Volume170
Issue number20
DOIs
StatePublished - Nov 8 2010

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Confidence Intervals
Social Adjustment
ST Elevation Myocardial Infarction
Non-ST Elevated Myocardial Infarction
Unstable Angina
Quality Improvement
Hospital Mortality
Smoking
Guidelines

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Ting, H. H., Chen, A. Y., Roe, M. T., Chan, P. S., Spertus, J. A., Nallamothu, B. K., ... Peterson, E. D. (2010). Delay from symptom onset to hospital presentation for patients with non- ST-segment elevation myocardial infarction. Archives of Internal Medicine, 170(20), 1834-1841. https://doi.org/10.1001/archinternmed.2010.385

Delay from symptom onset to hospital presentation for patients with non- ST-segment elevation myocardial infarction. / Ting, Henry H.; Chen, Anita Y.; Roe, Matthew T.; Chan, Paul S.; Spertus, John A.; Nallamothu, Brahmajee K.; Sullivan, Mark D.; DeLong, Elizabeth R.; Bradley, Elizabeth H.; Krumholz, Harlan M.; Peterson, Eric D.

In: Archives of Internal Medicine, Vol. 170, No. 20, 08.11.2010, p. 1834-1841.

Research output: Contribution to journalArticle

Ting, HH, Chen, AY, Roe, MT, Chan, PS, Spertus, JA, Nallamothu, BK, Sullivan, MD, DeLong, ER, Bradley, EH, Krumholz, HM & Peterson, ED 2010, 'Delay from symptom onset to hospital presentation for patients with non- ST-segment elevation myocardial infarction', Archives of Internal Medicine, vol. 170, no. 20, pp. 1834-1841. https://doi.org/10.1001/archinternmed.2010.385
Ting, Henry H. ; Chen, Anita Y. ; Roe, Matthew T. ; Chan, Paul S. ; Spertus, John A. ; Nallamothu, Brahmajee K. ; Sullivan, Mark D. ; DeLong, Elizabeth R. ; Bradley, Elizabeth H. ; Krumholz, Harlan M. ; Peterson, Eric D. / Delay from symptom onset to hospital presentation for patients with non- ST-segment elevation myocardial infarction. In: Archives of Internal Medicine. 2010 ; Vol. 170, No. 20. pp. 1834-1841.
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abstract = "Background: Secular trends and factors associated with delay time from symptom onset to hospital presentation are known for patients with ST-segment elevation myocardial infarction (STEMI) but are less well-described for non-STEMI. Methods: We studied 104 622 patients with non-STEMI enrolled at 568 hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) National Quality Improvement Initiative from January 1, 2001, to December 31, 2006. We examined secular trends and factors associated with delay time and the association of delay time with in-hospital mortality. Results: Median delay time from symptom onset to hospital presentation was 2.6 hours (interquartile range, 1.3-6.0) and has been stable from 2001 to 2006 (P value for trend, .16). After multivariable adjustment, factors associated with longer delay time included older age, female sex, nonwhite race, diabetes, and current smoking. In addition, compared with those who presented during weekday daytime (>8 AM to 4 PM), patients who presented during weekday and weekend nights (>12 AM to 8 AM) had a 24.7{\%} and 24.3{\%} shorter delay time, respectively (P<.001). After multivariable adjustment, the odds ratio of in-hospital mortality for patients with delay times of 0 to 1 hour or less, more than 1 to 2 hours, more than 2 to 3 hours, and more than 3 to 6 hours compared with the reference group (delay time >6 hours) were 1.19 (95{\%} confidence interval [CI], 1.08-1.30), 0.91 (95{\%} CI, 0.83-1.00), 0.77 (95{\%} CI, 0.69-0.88), and 0.90 (95{\%} CI, 0.81-1.00), respectively. Conclusions: Long delay times are common and have not changed over time for patients with non-STEMI. Because patients cannot differentiate whether symptoms are due to STEMI or non-STEMI, early presentation is desirable in both instances.",
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AU - Chen, Anita Y.

AU - Roe, Matthew T.

AU - Chan, Paul S.

AU - Spertus, John A.

AU - Nallamothu, Brahmajee K.

AU - Sullivan, Mark D.

AU - DeLong, Elizabeth R.

AU - Bradley, Elizabeth H.

AU - Krumholz, Harlan M.

AU - Peterson, Eric D.

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N2 - Background: Secular trends and factors associated with delay time from symptom onset to hospital presentation are known for patients with ST-segment elevation myocardial infarction (STEMI) but are less well-described for non-STEMI. Methods: We studied 104 622 patients with non-STEMI enrolled at 568 hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) National Quality Improvement Initiative from January 1, 2001, to December 31, 2006. We examined secular trends and factors associated with delay time and the association of delay time with in-hospital mortality. Results: Median delay time from symptom onset to hospital presentation was 2.6 hours (interquartile range, 1.3-6.0) and has been stable from 2001 to 2006 (P value for trend, .16). After multivariable adjustment, factors associated with longer delay time included older age, female sex, nonwhite race, diabetes, and current smoking. In addition, compared with those who presented during weekday daytime (>8 AM to 4 PM), patients who presented during weekday and weekend nights (>12 AM to 8 AM) had a 24.7% and 24.3% shorter delay time, respectively (P<.001). After multivariable adjustment, the odds ratio of in-hospital mortality for patients with delay times of 0 to 1 hour or less, more than 1 to 2 hours, more than 2 to 3 hours, and more than 3 to 6 hours compared with the reference group (delay time >6 hours) were 1.19 (95% confidence interval [CI], 1.08-1.30), 0.91 (95% CI, 0.83-1.00), 0.77 (95% CI, 0.69-0.88), and 0.90 (95% CI, 0.81-1.00), respectively. Conclusions: Long delay times are common and have not changed over time for patients with non-STEMI. Because patients cannot differentiate whether symptoms are due to STEMI or non-STEMI, early presentation is desirable in both instances.

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