患者认知度和社会经济因素对初次经皮冠状动脉介入治疗患者就诊的影响。

Impact of Patient Unawareness and Socioeconomic Factors on Patient Presentation to Primary Percutaneous Coronary Intervention.

机构信息

Tanta University, Tanta - Egito.

出版信息

Arq Bras Cardiol. 2022 Jul;119(1):25-34. doi: 10.36660/abc.20210521.

DOI:10.36660/abc.20210521

PMID:35830099

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9352125/

Abstract

BACKGROUND

Patient unawareness about acute myocardial infarction, its complications and the benefits of early revascularization is a crucial point that determines the outcomes. Moreover, the relationship between socioeconomic factors and patient presentation to primary percutaneous coronary intervention (PPCI) has not been fully studied.

OBJECTIVES

Our objective was to investigate whether or not patient unawareness and other socioeconomic factors impact patient presentation to PPCI.

METHODS

The study comprised 570 patients with ST-segment elevation myocardial infarction (STEMI) revascularized by PPCI. The patients were classified into two groups according to the total ischemia time (the time from STEMI symptom onset to balloon dilatation); group I: Patients with early presentation (1-12 hours). Group II: Patients with late presentation (>12-24 hours). Socioeconomic factors, clinical outcomes including mortality and major adverse cardiac events (MACE) were evaluated in each group. A p-value < 0.05 was considered statistically significant.

RESULTS

There are different socioeconomic factors affecting patient presentation to PPCI. Multivariate regression analysis identified the independent socioeconomic predictors as following: low educational level - OR 4.357 (CI95% 1.087-17.47, p=0.038), social isolation - OR 4.390 (CI95% 1.158-16.64, p=0.030) and unawareness about the benefits of early revascularization - OR 4.396 (CI95% 1.652-11.69, p=0.003). Mortality and MACE were higher in group II.

CONCLUSION

Patient unawareness and low socioeconomic status were associated with late presentation to PPCI with more adverse outcomes.

摘要

背景

患者对急性心肌梗死、其并发症以及早期血运重建的益处缺乏认知，这是决定治疗结局的关键因素。此外，社会经济因素与患者接受直接经皮冠状动脉介入治疗（PPCI）的关系尚未得到充分研究。

目的

本研究旨在探讨患者认知程度和其他社会经济因素是否会影响患者接受 PPCI 的时间。

方法

本研究纳入了 570 例接受 PPCI 治疗的 ST 段抬高型心肌梗死（STEMI）患者。根据总缺血时间（从 STEMI 症状发作到球囊扩张的时间）将患者分为两组：组 I：早期就诊患者（1-12 小时）；组 II：晚期就诊患者（>12-24 小时）。评估了每组患者的社会经济因素、临床结局（包括死亡率和主要不良心脏事件（MACE））。p 值<0.05 被认为具有统计学意义。

结果

有不同的社会经济因素影响患者接受 PPCI 的时间。多变量回归分析确定了以下独立的社会经济预测因素：低教育水平-比值比（OR）4.357（95%可信区间[CI]1.087-17.47，p=0.038）、社会孤立-OR 4.390（95%CI 1.158-16.64，p=0.030）和对早期血运重建益处的认知不足-OR 4.396（95%CI 1.652-11.69，p=0.003）。组 II 的死亡率和 MACE 更高。