TREATMENT DELAYS FOR THE ACTIVE INFARCT PATIENT-BEWARE THE DIABETIC!
C.M. Nunn*, H. Charleson, G. Devlin, H. McAlister, S. Heald, R. Fisher, C. Wade.
Department of Cardiology, Waikato Hospital, Hamilton, New Zealand.
Background: A major determinant of patient outcome following myocardial infarction (AMI) is the time reperfusion therapy is administered. Whilst minimising this delay is known to improve outcome, little is known about the determinants of these delays. We report on the experience obtained with a primary angioplasty program using prospectively recorded times.
Methods: All patient presenting with an AMI who were considered at high risk, were referred for primary angioplasty (PA). Clinical variables and the following times were prospectively recorded: pain onset, hospital arrival, notification of cardiologist, catheter laboratory arrival and time from hospital arrival to balloon inflation (TBI). Treatment times were analysed according to clinical variables and time of presentation.
Results: 1788 consecutive PA patients were reviewed. Mean age 61.2 yrs and 62% were male. Median times (mins) for the entire group were; pain onset to hospital arrival, 100; hospital arrival to calling cardiologist, 20; and TBI, 88. By univariate analysis diabetes and age greater than 70 were associated with increased presentation delays (150 vs 90, p=0.026 and 135 vs 90, p=0.077 respectively. Triage delays were increased in diabetics (35 vs 20 mins for non-diabetics, p=0.021. In patients presenting out of hours (5pm-8am) TBI was increased from 83.8mins to 99.4mins (p=0.02). Multiple regression analysis confirmed that both triage delays (p=0.006) and TBI (p=0.007) were predicted by diabetes but not time of day. Of note diabetic triage delays increased during working hours (see fig).
Conclusion: Treatment delays for reperfusion therapy are increased in diabetics. Of concern is the slower triage for diabetic patients during working hours, which may reflect reduced symptom severity in a busy ER.
