Original article Factors Associated With Delays in Seeking Medical Attention in Patients With ST-segment Elevation Acute Coronary Syndrome Fernando Rivero, a Teresa Bastante, a Javier Cuesta, a Amparo Benedicto, a Jorge Salamanca, a Jorge-Andre ´s Restrepo, a Rı ´o Aguilar, a Federico Gordo, b Maurice Batlle, c and Fernando Alfonso a, * a Servicio de Cardiologı´a, Hospital Universitario de la Princesa, IIS-IP, Universidad Auto ´noma de Madrid, Madrid, Spain b Servicio de Cuidados Intensivos, Hospital Universitario del Henares, Coslada, Madrid, Spain c Servicio de Cardiologı´a, Hospital Universitario del Henares, Coslada, Madrid, Spain Rev Esp Cardiol. 2016;69(3):279–285 Article history: Received 25 March 2015 Accepted 22 July 2015 Available online 4 December 2015 Keywords: Myocardial infarction Epidemiology Reperfusion Primary coronary intervention Reperfusion times A B S T R A C T Introduction and objectives: Prompt coronary reperfusion is crucial in patients with ST-segment elevation acute coronary syndrome. The aim of this study was to determine factors associated with a delay in seeking medical attention after the onset of symptoms in patients with this condition. Methods: Prospective cohort study in consecutive patients with ST segment elevation infarction. Multiple logistic regression analysis was used to identify factors independently associated with a longer delay in requesting medical help. Results: In total, 444 consecutive patients were included (mean age, 63 years; 76% men, 20% with diabetes). Median total ischemia time was 225 (160-317) minutes; median delay in seeking medical attention was 110 (51-190) minutes. Older patients (age > 75 years; odds ratio = 11.6), women (odds ratio = 3.4), individuals with diabetes (odds ratio = 2.3), and those requesting medical care from home (odds ratio = 2.2) showed the longest delays in seeking medical attention. Lengthy delay was associated with higher in- hospital mortality (9.8% vs 2.7%; P < .005) and 1-year mortality (7.3% vs 2.9%; P < .05) than when attention was promptly solicited. Conclusions: Elderly patients, women, and diabetic individuals with ST-segment elevation myocardial infarction show longer delays in seeking medical attention for their condition. Delays in seeking medical attention are associated with greater in-hospital and 1-year mortality. ß 2015 Sociedad Espan ˜ola de Cardiologı ´a. Published by Elsevier Espan ˜a, S.L.U. All rights reserved. Factores asociados al retraso en la demanda de atencio ´n me ´ dica en pacientes con sı ´ndrome coronario agudo con elevacio ´n del segmento ST Palabras clave: Infarto de miocardio Epidemiologı ´a Reperfusio ´n Intervencionismo coronario primario Tiempos de reperfusio ´n R E S U M E N Introduccio ´n y objetivos: La rapidez en la instauracio ´n de la reperfusio ´n coronaria es crucial para los pacientes con sı ´ndrome coronario agudo con elevacio ´n del segmento ST. El objetivo del estudio es determinar los factores asociados al retraso en la demanda de atencio ´n me ´ dica desde el inicio de los sı ´ntomas. Me ´todos: Se realizo ´ un estudio de cohortes prospectivo de pacientes consecutivos con infarto y elevacio ´n del ST. Se utilizo ´ un modelo de regresio ´n logı ´stica mu ´ ltiple para identificar los factores asociados de manera independiente con mayor retraso en la peticio ´n de asistencia sanitaria. Resultados: Se incluyo ´a 444 pacientes consecutivos (media de edad, 63 an ˜ os; el 76% varones, el 20% diabe ´ ticos). La mediana del tiempo total de isquemia fue de 225 (160-317) min; la mediana del retraso en la demanda de atencio ´n me ´ dica, 110 (51-190) min. Los pacientes ma ´s ancianos (edad > 75 an ˜os; odds ratio = 11,6), las mujeres (odds ratio = 3,4), los diabe ´ ticos (odds ratio = 2,3) y los que solicitaron asistencia desde su propio domicilio (odds ratio = 2,2) son los que ma ´s tardaron en pedir atencio ´ n. El mayor retraso en la demanda de atencio ´n me ´ dica se asocio ´a una mayor mortalidad durante el ingreso hospitalario (el 9,8 frente al 2,7%; p < 0,005) y al an ˜o (el 7,3 frente al 2,9%; p < 0,05). Conclusiones: Los pacientes ancianos, las mujeres y los diabe ´ ticos con infarto de miocardio y elevacio ´n del ST presentan mayor retraso en la demanda de atencio ´n me ´ dica. El retraso en la demanda de atencio ´n me ´ dica se asocia con mayor mortalidad durante el ingreso y al an ˜o. ß 2015 Sociedad Espan ˜ola de Cardiologı ´a. Publicado por Elsevier Espan ˜a, S.L.U. Todos los derechos reservados. * Corresponding author: Servicio de Cardiologı ´a, Hospital Universitario de la Princesa, IIS-IP, Universidad Auto ´ noma de Madrid, Diego de Leo ´n 64, 28006 Madrid, Spain. E-mail address: falf@hotmail.com (F. Alfonso). http://dx.doi.org/10.1016/j.rec.2015.07.029 1885-5857/ß 2015 Sociedad Espan ˜ola de Cardiologı ´a. Published by Elsevier Espan ˜a, S.L.U. All rights reserved. Document downloaded from https://www.revespcardiol.org/, day 04/12/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from https://www.revespcardiol.org/, day 04/12/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.