ABC | Volume 111, Nº4, Octuber 2018

Original Article Independent Predictors of Late Presentation in Patients with ST‑Segment Elevation Myocardial Infarction Juliane Araujo Rodrigues, Karina Melleu, Márcia Moura Schmidt, Carlos Antonio Mascia Gottschall, Maria Antonieta Pereira de Moraes, Alexandre Schaan de Quadros Instituto de Cardiologia / Fundação Universitária de Cardiologia – IC/FUC, Porto Alegre, RS – Brazil Mailing Adress: Alexandre Schaan de Quadros • Avenida Princesa Isabel, 370. Postal Code 90620-000, Santana, Porto Alegre, RS – Brazil E-mail: quadros.pesquisa@gmail.com, editoracap-pc@cardiologia.org.br Manuscript received August 22, 2017, revised manuscript March 07, 2018, accepted May 09, 2018 DOI: 10.5935/abc.20180178 Abstract Background: In patients with acute ST-segment elevation myocardial infarction (STEMI), the time elapsed from symptom onset to receiving medical care is one of the main mortality predictors. Objective: To identify independent predictors of late presentation in patients STEMI representative of daily clinical practice. Methods: All patients admitted with a diagnosis of STEMI in a reference center between December 2009 and November 2014 were evaluated and prospectively followed during hospitalization and for 30 days after discharge. Late presentation was defined as a time interval > 6 hours from chest pain onset until hospital arrival. Multiple logistic regression analysis was used to identify independent predictors of late presentation. Values of p < 0.05 were considered statistically significant. Results: A total of 1,297 patients were included, with a mean age of 60.7 ± 11.6 years, of which 71% were males, 85% Caucasians, 72% had a mean income lower than five minimum wages and 66% had systemic arterial hypertension. The median time of clinical presentation was 3.00 [1.40-5.48] hours, and approximately one-quarter of the patients had a late presentation, with their mortality being significantly higher. The independent predictors of late presentation were Black ethnicity, low income and diabetes mellitus, and a history of previous heart disease was a protective factor. Conclusion: Black ethnicity, low income and diabetes mellitus are independent predictors of late presentation in STEMI. The identification of subgroups of patients prone to late presentation may help to stimulate prevention policies for these high-risk individuals. (Arq Bras Cardiol. 2018; 111(4):587-593) Keywords: ST Elevation Myocardial Infarction; Emergency Medical Services; First Aid; Time Factors. Introduction In patients with acute ST-segment elevation myocardial infarction (STEMI), the time interval between symptom onset and hospital arrival (delta T) is one of the most consistent predictors of mortality. 1 Most deaths occur at the start of disease manifestation, and in the 40% to 65% of the cases, death occurs within the first hour, and in 80%, within the first 24 hours. 2 The benefit of myocardial reperfusion is time‑dependent, and the earlier the coronary flow is restored, the better the clinical evolution of the patient. 3 Although many advances have occurred in the last two decades, resulting in an important impact on morbidity and mortality, the postponing of treatment due to the delay in seeking medical attention is still a major problem in daily clinical practice. 4 Evidence in the literature indicates that female gender, marital status, Diabetes Mellitus (DM), Systemic Arterial Hypertension (SAH), atrial fibrillation, and age are predictors of hospital arrival delay. 5-10 However, there are few contemporary studies evaluating the predictors of late presentation in patients with AMI in the Brazilian setting. The identification of high-risk subgroups of late presentation in the general population could contribute to optimize strategies to reduce the time to access the health care system, with the potential to decrease adverse cardiac outcomes. The aim of this study was to identify predictors of late presentation in patients with STEMI that are representative of daily clinical practice. Methods Design and population All patients with STEMI treated at our institution from December 2009 to November 2014 were consecutively and prospectively included. Patients who arrived at the hospital more than 12 hours after symptom onset, those transferred from another health care service and those who refused to participate in the study were excluded. 587