Abstract 20127: Race and Insurance Status as Determinants of Prolonged Total Ischemic Time in ST Elevation Myocardial Infarction
Introduction: In STEMI, early reperfusion is imperative to preserve viability. The interval between steady ischemic symptom onset to first medical contact time (ST1) is a component of total ischemic time (IT) that has a large margin for improvement.
Hypothesis: We hypothesized that ST1 is the main contributor to IT and can be influenced by specific patient demographics, characteristics and socio-economical status.
Methods: We queried the database from an experienced urban-based STEMI accredited receiving center in Houston, TX from 2011 to 2014. We included only patients with STEMI who presented directly from the community to our hospital via EMS. IT was defined as the sum of ST1, first medical contact (FMC) to hospital arrival and arrival to first device activation (FDA) times. Patients transferred from outside facilities or without documented symptom onset, FMC or FDA times were excluded.
Results: 263 patients met the inclusion criteria: 52% White, 28% Black and 17% Hispanic. 48% had private insurance, 38% Medicare and 8% Medicaid. Mean ST1 was 117, FMC to arrival 49 and arrival to FDA 58 min. Mean ST1 comprised 41.7% of IT. Compared to other groups, the Black race was independently associated with the longest ST1 time at 156 ± 234 min (p = 0.05), Similarly, Medicaid insurance status showed the highest ST1 time at 283 ± 396 min (p <0.01).
Conclusions: 1. Symptoms onset to first medical contact time (ST1) has the largest impact on total ischemic time in STEMI.
2. Black race and Medicaid insurance status are associated with a longer ST1 time.
3. Continued public education regarding prolonged myocardial ischemia is needed.
Author Disclosures: K.I. Khalaf: None. S. Sdringola: None. P. Balan: None. H.V. Anderson: None. J. McCarthy: None. J. Langabeer: None. S. Choi: None. R.W. Smalling: None.
- © 2014 by American Heart Association, Inc.