The Influence of Demographic Factors on the Pain to Door Time in ST Elevation Myocardial Infarction

Background: The time from symptom onset to hospital admission (PTD) is prognostically important in STEMI patients. Geographic, socioeconomic and demographic factors have been related to this time interval. The impact of demographic factors on the PTD time in Israel is not well studied.

Aim: To identify predictors of pain to door balloon time in STEMI patients treated by primary PCI.

Methods and Results: We analyzed data for 1267 STEMI patients treated by primary PCI who live within 60 kilometers of our medical center and were admitted between 07/2004-07/2015. We examined the impact of age, gender, ethnicity, time during the week of symptom onset, distance to the hospital, and socioeconomic level of the corresponding city on PTD times. Overall age was 60.3±12.8 years, 79% were men and 74% were Jews. The mean distance to the hospital was 20.7±14.3 km. The mean PTD time was 4 ±6.8 hours. Half the patients were admitted within 2 hours of symptom onset. Bedouin women had longer PTD times in comparison to other gender-ethnicity groups (7.2 ± 13.4 vs. 3.9 ± 6.3, p<0.001). In a multivariate analysis the following factors were found as independently associated with PTD time: age (Beta 0.071; p=0.011); Bedouin women (Beta=0.095; p=0.001); distance from home to the medical center (Beta=0.059; p=0.035) and onset of pain on Saturday morning (Beta=0.064; p<0.021.

Conclusion: Age, distance to the medical center, gender and ethnicity have strong influence on the pain to door time. Bedouin women seem to have particularly prolonged PTD times. Efforts to increase awareness of MI symptoms and the importance of early call for help should be focused on these high risk subgroups.