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

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.