School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460, USA.
J Cardiovasc Nurs. 2011 May-Jun;26(3):184-93. doi: 10.1097/JCN.0b013e3181efea66.
Rapid arrival to the hospital for treatment of acute myocardial infarction (AMI) improves long-term outcomes. Whether prehospital delay time is associated with short-term, in-hospital complications remains unknown.
The purpose of this study was to evaluate the fit of a theoretical model where prehospital delay time was indirectly associated with hospital length of stay through in-hospital complications after AMI considering simultaneously for demographic, clinical, and psychosocial factors using structural equation modeling.
Acute myocardial infarction patients (N = 536; 66% men; mean age, 62 [SD, 14] years) were enrolled in this prospective study. Demographic and clinical data were obtained by patient interview and medical record review. After patient discharge, complications were abstracted from the medical record.
Prehospital delay, admission Killip class, and in-hospital anxiety were the best predictors of in-hospital complications, including recurrent ischemia, reinfarction, sustained ventricular tachycardia or fibrillation, and cardiac death, after AMI (P = .019). The occurrence of in-hospital complications was related to length of stay in the hospital (P < .001).
Prehospital delay in promptly seeking hospital treatment for AMI symptoms, together with state anxiety and worse heart failure, was associated with the occurrence of more frequent serious complications during the hospital stay. It is essential that research and clinical efforts focus on the complex and dynamic issue of improving prehospital delay in AMI patients.
急性心肌梗死（AMI）患者尽快到医院接受治疗可改善长期预后。发病至入院的时间（prehospital delay time）与 AMI 患者短期住院期间的并发症之间是否存在关联尚不清楚。
本研究旨在通过结构方程模型，同时考虑人口统计学、临床和心理社会因素，评估一个理论模型的拟合度，该模型假设发病至入院的时间通过 AMI 后的院内并发症间接地与住院时间相关。
本前瞻性研究纳入了 536 例 AMI 患者（66%为男性；平均年龄 62[SD 14]岁）。通过患者访谈和病历回顾获取人口统计学和临床数据。患者出院后，从病历中提取并发症数据。
发病至入院的时间、入院时的 Killip 分级和住院期间的焦虑是 AMI 后院内并发症（包括再次发生缺血、再梗死、持续性室性心动过速或心室颤动和心源性死亡）的最佳预测因素（P =.019）。院内并发症的发生与住院时间有关（P <.001）。
AMI 症状发作后尽快到医院治疗而导致的发病至入院的时间延迟，以及发病时的焦虑状态和更严重的心衰，与住院期间更频繁发生严重并发症有关。研究和临床工作必须关注改善 AMI 患者发病至入院时间这一复杂且动态的问题。
