State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, People's Republic of China.
Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Am J Emerg Med. 2014 Apr;32(4):349-55. doi: 10.1016/j.ajem.2013.12.053. Epub 2014 Jan 3.
Prehospital delay is the most critical factor to prognosis of ST-elevation myocardial infarction (STEMI). Few study had examined a series of predictors of prehospital delay by multivariate analysis of sociodemographic and clinical characteristics, onset features, and symptom condition of STEMI in China.
A total of 1088 hospitalized STEMI participants were screened to collect sociodemographic data, medical history information, and symptom onset status from clinical medical records. Factors associated with prehospital delay were examined using bivariate and multivariate analysis method.
The median prehospital delay time (PDT) was 130 minutes in STEMI participants. Multivariate regression models examining 8 predictors were associated with prehospital delay, including senior high school or above educational level, myocardial infarction (MI) history, vertigo onset symptom, ambulance transportation, onset in daytime (6:00-18:00), onset at home, anterior wall MI, and posterior wall MI. Mortality in PDT more than 120 minutes group was 5.5%, whereas it was 4.3% in PDT 120 minutes of less group without significant statistically difference (P > .05).
Multivariate analysis results found that symptom onset-related variables strongly influenced PDT. Onset-related status of STEMI needed to be combined into interventions of participants, and more emergency education should be recommended to both participants and their relatives. Most importantly, more efforts should be taken to educate the public about the symptoms and signs to increase the recognition of STEMI.
院前延误是影响 ST 段抬高型心肌梗死（STEMI）患者预后的最关键因素。既往研究多采用单因素分析方法探讨社会人口学及临床特征、发病特征和症状对 STEMI 患者院前延误的影响，很少有研究采用多因素分析方法探讨这些因素与 STEMI 患者院前延误的关系。
连续纳入我院住院治疗的 STEMI 患者，通过查阅病历采集患者的社会人口学资料、既往病史信息和症状发病情况，采用单因素和多因素分析方法分析与 STEMI 患者院前延误相关的因素。
共纳入 1088 例 STEMI 患者，中位院前延误时间为 130 分钟。多因素回归模型分析显示，8 个因素与 STEMI 患者的院前延误相关，包括文化程度为高中及以上、有心肌梗死病史、眩晕起病症状、使用救护车转运、白天（6：00-18：00）发病、在家中发病、前壁心肌梗死和后壁心肌梗死。院前延误时间超过 120 分钟组患者的死亡率为 5.5%，而院前延误时间小于等于 120 分钟组患者的死亡率为 4.3%，差异无统计学意义（P＞0.05）。
多因素分析结果显示，症状发病相关变量与 STEMI 患者的院前延误时间密切相关。需要将 STEMI 的发病相关状况纳入患者的干预措施中，并向患者及其家属推荐更多的急救教育。最重要的是，应加大对公众进行 STEMI 相关症状和体征识别的教育力度。
