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Factors Affecting Time to Presentation in ST-Elevation Myocardial Infarction(FAT STEMI)

David Spencer Hamilton*, Hambik Tankazyan DO, Tigran Khachatryan, Amar Desai, Jonathan Evans BS, Eric Suh MPH, Yong Ji, Islam Abudayyeh, Kenneth Jutzy and Anthony Hilliard

Introduction: Advancements in ST-Elevation Myocardial Infarction (STEMI) management have led to improved outcomes and decreased mortality in recent decades. A critical factor in this improvement was developing hospital systems to decrease emergency room door to cath lab balloon times of less than 90 minutes. Continued efforts to decrease total ischemic time by reducing time to presentation are an area for further improvement. Identifying factors that affect the time from the onset of symptoms to presentation can provide hospital systems additional opportunities to improve outcomes of STEMI patients.

Methods: Utilizing a single center, retrospective chart review, 604 STEMI activations were identified. After false activations were excluded, the remaining 529 patient cases were analyzed for various factors and variables affecting the time to presentation (TTP), including age, mode of transportation, race, language, and diabetic status.

Results: The variables found to be statistically significant with their effect on time to presentation to the hospital included race (p=0.024), mode of transportation (p=0.021), and diabetic status (p=0.0054). Additionally for every unit increase in Hgb A1c, TTP increased 1.12 minutes (R2=0.49). Time to presentation showed no statistically significant difference based on age (p=0.60), sex (p=0.15), ethnicity (p=0.46), language (p=0.20) or religion (p=0.15).

Conclusions: Mode of transportation, race, and diabetes status had a significant impact on the time from the onset of symptoms to presentation in patients with STEMI. The use of EMS decreases the time to presentation compared to self-transport. Patients, who identify themselves in the “Other” race category, including American Indians, Pacific Islanders, and Native Hawaiians, exhibited longer TTP. Diabetics took longer to present than their non-diabetic counterparts. Interestingly, no differences in TTP were found when comparing age, sex, ethnicity (Hispanic vs. non-Hispanic), language or religion.