Pre-hospital delay in patients with acute myocardial infarction in China:findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS)project

摘要

OBJECTIVE To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction(AMI)in China.METHODS Data were collected from November 2014 to December 2019 as part of the Improving Care for Cardiovascular Dis-ease in China-Acute Coronary Syndrome(CCC-ACS)project.A total of 33,386 patients with AMI admitted to the index hospitals were included in this study.Two-level logistic regression was conducted to explore the factors associated with the pre-hospital delay and the associations between different pre-hospital delay and in-hospital outcomes.RESULTS Of the 33,386 patients with AMI,70.7%of patients arrived at hospital≥2 h after symptom onset.Old age,female,ru-ral medical insurance,symptom onset at early dawn,and non-use of an ambulance predicted a prolonged pre-hospital delay(all P<0.05).Hypertension and heart failure at admission were only significant in predicting a longer delay in patients with ST-seg-ment elevation myocardial infarction(STEMI)(all P<0.05).A pre-hospital delay of≥2 h was associated with an increased risk of mortality[odds ratio(OR)=1.36,95%CI:1.09-1.69,P=0.006]and major adverse cardiovascular events(OR=1.22,95%CI:1.02-1.47,P=0.033)in patients with STEMI compared with a pre-hospital delay of<2 h.CONCLUSIONS Prolonged pre-hospital delay is associated with adverse in-hospital outcomes in patients with STEMI in China.Our study identifies that patient characteristics,symptom onset time,and type of transportation are associated with pre-hospital delay time,and provides focuses for quality improvement.