The Research Into The Time Distribution Of PCI Treatment Delay And The Influential Factors In Patients With Acute ST-segment Elevation Myocardial Infarction

Objective:This study aims to investigate factors influencing the time-delay between the onset of acute ST Segment Elevation Myocardial Infarction(STEMI)and the operation of percutaneous transluminal coronary angioplasty(the STEMI-PTCA time-delay)and the relevant possible improvement methods by analysing selected cases in First Affiliated Hospital of Kunming Medical University.Methods:The relevant data of STEMI-PTCA time-delay was collected through retrospective analysis of selected cases of STEMI with PTCA treatment in the period of time from July 2013 to July 2016 in First Affiliated Hospital of Kunming Medical University.In this study,a total of 327 comparatively fully recorded cases were selected for analysis.Including demographic characteristics,clinical data,Treatment time distribution was recorded.Based on prehospital time-delay(prehospital delay),cases were categorized into prehospital delay group(cases wit?6 hours prehospital delay)and prehospital non-delay group(cases with<6 hours prehospital delay);Based on the intra-hospital time-delay(intrahospital delay),according to the guide made by American College of Cardiology,cases were categorized into intra-hospital delay group(cases with ?90 min intra-hospital delay)and intra-hospital non-delay group(cases with<90 min intra-hospital delay).Factors affecting STEMI-PTCA time were investigated by the logistic regression analysis of selected cases along with the information of demography and other related clinical factors.Results:1.Among a total of 327 selected cases,152 cases were within prehospital non-delay group,among which 93 cases had a prehospital delay less than 3 hours,with an average delay time of 2.39±0.75 hours,account for 28.7%of all selected cases;59 cases had a prehospital delay between 3 to 6 hours,with an average delay time of 4.62±0.86 hours,accounting for 17.7%of all selected cases.Prehospital delay group had a total of 175 cases,among which 161 cases had a prehospital delay between 6 to 9 hours,with an average delay of 7.93±0.74 hours,accounting for 49.5%of all selected cases;14 cases had a prehospital delay more than 9 hours,with an average delay of 10.14±0.36 hours,accounting for 4.3%of all selected cases.Univariate regression Logistic analysis showed that there were significant correlations between the prehospital delay and prehospital non-delay groups in terms of age,typical chest pain,the use of EMS,status of anxiety,patient transport,history of angina,and heart-disease-related symptoms(P<0.05).Multivariate regression Logistic analysis showed that prehospital delay was statistically correlated with age,the use of EMS,presence of typical chest pain,patient transport,and history of angina(P<0.05),with a negative regression coefficient for the use of EMS and presence of typical chest pain,and a positive one for age,patient transport and history of angina.2.163 cases were intra-hospital non-delayed,among which 4 cases had an intra-hospital delay below 30 min,with an average of 26.50±2.08 min,accounting for 1.2%of all selected cases;94 cases had an intra-hospital delay between 30 to 60 min,with an average of 49.69±7.45 min,accounting for 28.7%of all selected cases;65 cases had an in-hospital delay between 60 to 90 min,with an average of 71.14±7.29 min,accounting for 19.9%of all selected cases.164 cases were intra-hospital delayed,with an average of 128.20±12.26 min,accounting for 50.4%of all selected cases.Univariate regression Logistic analysis showed that there were significant correlations(p<0.05)between these two groups in terms of the presence of diabetes and patient's perception of symptom severity.Multivariate regression Logistic analysis demonstrated that intra-hospital delay was significantly correlated with patient's perception of symptom severity(P=0.029).Conclusions:Our hospital's treatment time still lags far behind the international standard.There is a big gap of treatment delay rate between our hospital and developed countries.1.Old age,transfer,angina history will make the hospital before the delay time,so that EMS,typical chest pain can reduce the delay before the hospital.2.pain continued to ease more likely to cause the concern of clinicians,it can reduce the hospital delay time.3.There are many factors influencing the treatment time.Those factors should be considered based on the specific circumstances and conditions of different regions,hospitals and clinical cases.But with the development of economy and education,the popularity of medical and health knowledge,the improvement of healthcare in China,treatment has now gradually become standardized,efficient,and successful.A large number of patients are able to receive timely treatment.