Clinical impact of symptom-to-door time on 1-year mortality in patients with non-ST segment elevation acute myocardial infarction

Sun Ok Lee,; R.N.,; Sang Eun Oh,; R.N.,; Myung Ho Jeong,; Hyun Kuk Kim,; Hae Jung Jeon,; R.N.,; Young Ja Choi,; R.N.,; Sung Soo Kim,; Jum Suk Ko,; Min Goo Lee,; Doo Sun Sim,; Keun Ho Park,; Nam Sik Yoon,; Hyun Ju Yoon,; Hyung Wook Park,; Kye Hun Kim,; Young Joon Hong,; Ju Han Kim,; Youngkeun Ahn,; Jeong Gwan Cho,; Jong Chun Park,; Jung Chaee Kang,

Korean J Med > Volume 78(6); 2010 > Article

Original Article

The Korean Journal of Medicine 2010;78(6):717-724.

Clinical impact of symptom-to-door time on 1-year mortality in patients with non-ST segment elevation acute myocardial infarction

Sun Ok Lee, R.N., Sang Eun Oh, R.N., Myung Ho Jeong, Hyun Kuk Kim, Hae Jung Jeon, R.N., Young Ja Choi, R.N., Sung Soo Kim, Jum Suk Ko, Min Goo Lee, Doo Sun Sim, Keun Ho Park, Nam Sik Yoon, Hyun Ju Yoon, Hyung Wook Park, Kye Hun Kim, Young Joon Hong, Ju Han Kim, Youngkeun Ahn, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang

ST분절 비상승 심근경색증 환자에서 증상발생 후 병원 도착 시간이 일년 후 사망률에 미치는 임상적 영향

이선옥, 오상은, 정명호, 김현국, 전해정, 최영자, 김성수, 고점석, 이민구, 심두선, 박근호, 윤남식, 윤현주, 박형욱, 김계훈, 홍영준, 김주한, 안영근, 조정관, 박종춘, 강정채, Youngkeun Ahn, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang

Abstract

Background/Aims: Symptom-to-door time is associated with the prognosis for ST-segment elevation myocardial infarction. However, this value has not been a concern in patients with non-ST segment elevation myocardial infarction (NSTEMI). The aim of this study was to assess the relationship between symptom-to-door time and clinical outcomes in patients with NSTEMI. Methods: In total, 1,971 patients with NSTEMI (64.8±12.1 years, 23.6% women) were enrolled between Nov. 2005 and Jan. 2008. The patients were divided into two groups according to the time difference between the presentation of symptoms and first medical contact: group I (<12 hours, n=1433) and group II (>12 hours, n=538). One-year mortality rates were compared between the groups. Thrombolysis In Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores were calculated in all study patients. Results: The mean age was 64.4±12.2 years in group I and 65.6±12.0 years in group II (p=0.046). No significant differences existed between the two groups, except for the prevalence of hypertension, diabetes mellitus, initial systolic blood pressure, and initial serum creatinine levels. One-year mortality rates decreased significantly in group I patients [hazard ratio (HR)=1.35, 95% CI (confidential interval): 1.03~1.75, p=0.028] based on a multivariate Cox proportional analysis, which was adjusted by GRACE score, baseline characteristic variables, and predictors of a 1-year mortality in a univariate analysis. In intermediate-to high-risk patients (n=1,184, defined as having a TIMI risk score above 3 points), significant differences were observed in mortality rates between the two groups (HR=1.35, 95% CI: 1.02~1.80, p=0.037); the low-risk patients (n=787, HR=1.57, 95% CI: 0.80~3.05, p=0.188), however, showed no such differences. Conclusions: Symptom-to-door time was an independent long-term clinical predictor in patients with NSTEMI, especially in intermediate- to high-risk groups. (Korean J Med 78:717-724, 2010)

Key Words: Myocardial infarction; Prognosis; Symptoms