Factors associated with delay of reperfusion-decision for patients with ST-segment elevation myocardial infarction

<p><b>OBJECTIVE</b>To determine lengths and factors associated with delay of reperfusion-decision in patients with acute ST-segment elevation myocardial infarction (STEMI).</p><p><b>METHODS</b>This cross-sectional and multicenter survey was conducted in 19 hospitals from Beijing between 1 January and 31 December, 2006 and included STEMI patients receiving thrombolysis or primary percutaneous coronary intervention (PCI). Data were collected by structured interviews and medical records review within 1 week after admission. Reperfusion-decision delay was defined as time interval from the initial ECG after admission to sign of the thrombolysis or operation approval. Patients were categorized into an early decision group and a late decision group based on the 30 min cut-off time.</p><p><b>RESULTS</b>Of the 635 STEMI patients interviewed, 129 (20.3%) received thrombolysis, and the remaining 506 (79.7%) received primary PCI. The median reperfusion-decision delay was 47 min. The median door-to-needle time was 82 min, and the median door-to-balloon time was 135 min. Multivariate logistic analysis showed that awareness of the time-dependent nature of reperfusion therapy (OR = 1.723, 95% CI: 1.156-3.212, P = 0.040), pre-hospital electrocardiogram (OR = 1.566, 95% CI: 1.018-2.409, P = 0.036), cardiac function of Killip > or = 2 at admission (OR = 1.579, 95% CI: 1.004-2.483, P = 0.021) and presenting to cardiovascular specialty hospital (OR = 5.075, 95% CI: 1.380-18.655, P = 0.014) were independent predictors early reperfusion-decision delay. Patients in early decision group had significantly shorter median door-to-needle (47 vs. 103 min, P < 0.001) and door-to-balloon (100 vs. 154 min, P < 0.001) times compared to patients in late decision group.</p><p><b>CONCLUSIONS</b>The main reason of the in-hospital delay of reperfusion therapy of STEMI patients is reperfusion-decision delay. New public health strategies should be developed to educate patients and their family members to increase their awareness of the importance and benefits of prompt reperfusion therapy and facilitate the pre-hospital electrocardiogram recording for STEMI patients.</p>