非ST段抬高型心肌梗死患者从症状发作到入院就诊的延迟时间。

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

作者信息

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

机构信息

Division of Cardiovascular Diseases and Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.

出版信息

Arch Intern Med. 2010 Nov 8;170(20):1834-41. doi: 10.1001/archinternmed.2010.385.

DOI:10.1001/archinternmed.2010.385

PMID:21059977

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.

摘要

背景

ST段抬高型心肌梗死（STEMI）患者从症状发作到入院就诊的延迟时间的长期趋势及相关因素已为人所知，但非STEMI患者的相关情况描述较少。

方法

我们研究了2001年1月1日至2006年12月31日期间在568家医院登记的104622例非STEMI患者，这些医院参与了美国心脏病学会/美国心脏协会指南早期实施的不稳定型心绞痛患者快速风险分层抑制不良结局（CRUSADE）国家质量改进倡议。我们研究了延迟时间的长期趋势及相关因素，以及延迟时间与住院死亡率的关联。

结果

从症状发作到入院就诊的中位延迟时间为2.6小时（四分位间距，1.3 - 6.0），且在2001年至2006年期间保持稳定（趋势P值为0.16）。多变量调整后，与较长延迟时间相关的因素包括年龄较大、女性、非白人种族、糖尿病和当前吸烟。此外，与在工作日白天（上午8点至下午4点）就诊的患者相比，在工作日和周末夜间（凌晨12点至上午8点）就诊的患者延迟时间分别缩短了24.7%和24.3%（P < 0.001）。多变量调整后，延迟时间为0至1小时或更短、超过1至2小时、超过2至3小时以及超过3至6小时的患者与参考组（延迟时间>6小时）相比，住院死亡率的比值比分别为1.19（95%置信区间[CI]，1.08 - 1.30）、0.91（95% CI，0.83 - 1.00）、0.77（95% CI，0.69 - 0.88）和0.90（95% CI，0.81 - 1.00）。