Independent Predictors of Late Presentation in Patients with ST-Segment Elevation Myocardial Infarction

Abstract Background: In patients with acute ST-segment elevation myocardial infarction (STEMI), the time elapsed from symptom onset to receiving medical care is one of the main mortality predictors. Objective: To identify independent predictors of late presentation in patients STEMI representative of daily clinical practice. Methods: All patients admitted with a diagnosis of STEMI in a reference center between December 2009 and November 2014 were evaluated and prospectively followed during hospitalization and for 30 days after discharge. Late presentation was defined as a time interval > 6 hours from chest pain onset until hospital arrival. Multiple logistic regression analysis was used to identify independent predictors of late presentation. Values of p < 0.05 were considered statistically significant. Results: A total of 1,297 patients were included, with a mean age of 60.7 ± 11.6 years, of which 71% were males, 85% Caucasians, 72% had a mean income lower than five minimum wages and 66% had systemic arterial hypertension. The median time of clinical presentation was 3.00 [1.40-5.48] hours, and approximately one-quarter of the patients had a late presentation, with their mortality being significantly higher. The independent predictors of late presentation were Black ethnicity, low income and diabetes mellitus, and a history of previous heart disease was a protective factor. Conclusion: Black ethnicity, low income and diabetes mellitus are independent predictors of late presentation in STEMI. The identification of subgroups of patients prone to late presentation may help to stimulate prevention policies for these high-risk individuals.

摘要 背景：在急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）患者中，从症状发作至接受医疗救治的时间间隔是主要的死亡预测因素之一。目的：明确符合日常临床实践特征的STEMI患者就诊延迟的独立预测因素。方法：选取2009年12月至2014年11月期间，某参考中心收治的确诊STEMI患者作为研究对象，对其进行评估，并在住院期间及出院后30天内开展前瞻性随访。就诊延迟被定义为从胸痛发作至抵达医院的时间间隔超过6小时。采用多因素logistic回归分析识别就诊延迟的独立预测因素，以P<0.05为具有统计学显著性的判定标准。结果：本研究共纳入1297例患者，平均年龄为60.7±11.6岁，其中71%为男性，85%为白人，72%的患者家庭平均收入低于5倍最低工资标准，66%的患者合并系统性动脉高血压。患者就诊的中位时间为3.00[1.40-5.48]小时，约四分之一的患者存在就诊延迟情况，该类患者的死亡率显著更高。就诊延迟的独立预测因素包括黑人种族、低收入状态与糖尿病，而既往心脏病史则为保护因素。结论：黑人种族、低收入状态与糖尿病是STEMI患者就诊延迟的独立预测因素。识别易出现就诊延迟的患者亚群，有助于推动针对此类高危人群的预防政策制定。