Clinical Outcomes in Patients With Delayed Hospitalization for Non–ST-Segment Elevation Myocardial Infarction

Jung Joon Cha, Sung A. Bae, Duk Woo Park, Jae Hyoung Park, Soon Jun Hong, Seong Mi Park, Cheol Woong Yu, Seung Woon Rha, Do Sun Lim, Soon Yong Suh, Seung Hwan Han, Seong Ill Woo, Nae Hee Lee, Donghoon Choi, In Ho Chae, Hyo Soo Kim, Young Joon Hong, Youngkeun Ahn, Myung Ho Jeong, Tae Hoon Ahn

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8 Citations (Scopus)


Background: Recently, the number of patients presenting with non–ST-segment elevation myocardial infarction (NSTEMI) has reduced, whereas increased mortality was reported. A plausible explanation for increased mortality was prehospital delay because of patients’ reticence of their symptoms. Objectives: The purpose of this study was to investigate the association between prehospital delay and clinical outcomes in patients with NSTEMI Methods: Among 13,104 patients from the Korea-Acute-Myocardial-Infarction-Registry–National Institutes of Health, the authors evaluated 6,544 patients with NSTEMI. Study patients were categorized into 2 groups according to symptom-to-door (StD) time (<24 or ≥24 hours). The primary outcome was 3-year all-cause mortality, and the secondary outcome was 3-year composite of all-cause mortality, recurrent MI, and hospitalization for heart failure. Results: Overall, 1,827 (27.9%) patients were classified into the StD time ≥24 hours group. The StD time ≥24 hours group had higher all-cause mortality (17.0% vs 10.5%; P < 0.001) and incidence of secondary outcomes (23.3% vs 15.7%; P < 0.001) than the StD time <24 hours group. The higher all-cause mortality in the StD time ≥24 hours group was observed consistently in the subgroup analysis regarding age, sex, atypical chest pain, dyspnea, Q-wave in electrocardiogram, use of emergency medical services, hypertension, diabetes mellitus, chronic kidney disease, left ventricle dysfunction, TIMI (Thrombolysis In Myocardial Infarction) flow, and the GRACE risk score. In the multivariable analysis, independent predictors of prehospital delay were the elderly, women, nonspecific symptoms such as atypical chest pain or dyspnea, diabetes, and no use of emergency medical services. Conclusions: Prehospital delay is associated with an increased risk of 3-year all-cause mortality in patients with NSTEMI. (iCReaT Study No.

Original languageEnglish
Pages (from-to)311-323
Number of pages13
JournalJournal of the American College of Cardiology
Issue number4
Publication statusPublished - 2022 Feb 1

Bibliographical note

Funding Information:
This work was funded by the Research of Korea Centers for Disease Control and Prevention (2016-ER6304-02). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Funding Information:
The authors thank Nak Hoon Son (Division of Biostatistics, Yongin Severance Hospital, Yonsei University College of Medicine) for their assistance in statistical analyses and thank the Medical Research Support Services of Yonsei University College of Medicine for all artistic support related to this work.

Funding Information:
The data used in this study were derived from the nationwide, multicenter, prospective KAMIR–NIH (Korea Acute Myocardial Infarction Registry–National Institutes of Health) registry. The KAMIR–NIH registry included multiple centers in South Korea, was supported by a grant from the Korea Centers for Disease Control and Prevention from November 2011 to December 2015, and did not feature any exclusion criteria. The detailed study protocols have been published previously. 10 The protocol of the KAMIR–NIH registry was approved by the ethics committee at each participating center and was conducted in accordance with the principles of the Declaration of Helsinki. All patients provided written informed consent upon enrollment. All data were collected by independent clinical research coordinators, using a web-based case report form in the Internet-based Clinical Research and Trial Management System (iCReaT), a data management system established by the Centers for Disease Control and Prevention, Ministry of Health and Welfare, Republic of Korea (iCReaT Study No. C110016; KCT-0000863).

Publisher Copyright:
© 2022 American College of Cardiology Foundation

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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