Abstract 21158: Atypical Symptoms are Associated with Delays to Hospital Presentation and Prolonged Door to Balloon Times in Patients with ST Elevation Myocardial Infarction
Background: A comprehensive and rapid assessment of patients with STEMI is essential to improve total ischemic time. Prior studies suggest that patients with atypical symptoms have a longer symptom onset to presentation time (S2PT) and door to balloon time (D2PT). There is limited data on the association of the different types of symptoms of MI with S2PT and D2BT.
Objectives: To estimate the association of different symptom presentations on D2BT and S2PT.
Methods: Consecutive patients presenting to one of 4 hospitals in NYC with STEMI and referred for primary angioplasty were evaluated. Clinical and demographic variables were recorded. A patients' symptoms at the time of MI, as well as patterns of behavior following the onset of symptoms were assessed by telephone interview performed during routine follow-up. Multiple logistic regression analyses were performed to estimate the association between D2BT, S2PT and the primary variables of interest.
Results: Among 105 patients 60 (57%) presented with chest pain (CP), and 45 (43%) had atypical symptoms; (12 (11%) had shortness of breath SOB), 15 (14%) had gastrointestinal (GI) symptoms and 18 (17%) had other symptoms). The baseline variables and S2PT and D2BT for patients with CP vs. atypical symptoms are depicted in the table. When a multivariate logistic regression was performed for the odds of S2P time > 2hours, patients presenting with GI symptoms had the highest odds (4.30; 95% CI 1.22–15.14;p=0.02), while SOB had the highest odds for a D2B > 90 minutes, (Odds Ratio 5.06; 95% CI 1.34–19.03;p=0.01).
Conclusion: Atypical symptoms during STEMI are common and significantly influence the D2BT and S2PT. GI symptoms appear to have the greatest impact on S2PT, and SOB is associated with prolonged D2BT. Patient education outlining the potential for atypical symptoms during an MI is crucial for earlier patient presentation, and EMS-ER staff must maintain a high index of suspicion when triaging patients with these symptoms.
- Cardiovascular disease
- Percutaneous coronary intervention
- Patient education/teaching psychosocial aspects
- Emergency care
- © 2010 by American Heart Association, Inc.