Abstract 306: Impact of First Medical Contact on Symptom Onset to Door Time in Patients Presenting for Primary Percutaneous Coronary Intervention
Background: Shorter pre-hospital delays in ST-elevation myocardial infarction (STEMI) are associated with improved outcomes. Whether first medical contact type is related to symptom onset to door time (SODT) remains unknown.
Methods: We performed a retrospective chart review of all consecutive patients treated with primary percutaneous coronary intervention (PCI) for STEMI at our tertiary care suburban teaching hospital from October 1, 2005 to December 31, 2009. We compared SODT in patients whose first medical contact was a private physician, in person or via telephone; and patients who presented to the Emergency Department (ED) directly, in person or via Emergency Medical Services (EMS).
Results: Of 366 patients (table), 84 (23%) contacted a physician (group A) while 282 (77.6%) did not (group B). Group A was associated with higher median SODT (239.5 vs. 130 minutes, p=0.0043) and a trend to higher mortality at a median follow-up of 3.85 years (17.86% vs. 10.64%, p=0.089). Multiple linear regression analysis revealed two factors to be independently associated with prolonged SODT: 1) first contact (physician vs. no physician), p=0.002, regression coefficient=0.547, standard error (SE)=0.171, indicating a 73% increase in SODT if patients first contacted physicians and 2) mode of transportation (EMS vs. personal), p=0.016, regression coefficient=0.349, SE=0.144, indicating a 30% decrease in SODT if EMS was used. Patients presenting during “on-hours” (weekdays) were more likely to first contact a physician compared with those presenting during “off-hours” (weeknights and weekends) (66.67% in group A vs. 45.04% in group B, p<0.001).
Conclusions: Patients whose first medical contact was a physician had greater pre-hospital delays compared to those who sought emergent medical care directly, and a trend to higher mortality. This pattern occurred more often during “on-hours”. Educational efforts aimed at both patient and physician office practices are warranted.
- © 2012 by American Heart Association, Inc.