ABC | Volume 111, Nº4, Octuber 2018

Original Article Rodrigues et al Predictors of late presentation in ST-elevation myocardial infarction Arq Bras Cardiol. 2018; 111(4):587-593 Table 1 – Basal characteristics of patients Characteristic Total n = 1.297 < 6 hours n = 995 ≥ 6 hours n = 302 p Value Sociodemographic data Female gender 29 26 37 0.001 Age 60 .7 ± 11.6 60 ± 11.7 62 ± 11.5 0.82 Black ethnicity 15 13 19 0.009 Income < 5 minimum wages 72 69 82 < 0.001 Schooling ≤ 8 (years) 52 50 60 0.008 Delta T (hours) 3. 00 [1.40-5.48] 2.16 [1.00-3.70] 8.50 [7.00-11.87] Risk factors for CAD Arterial hypertension 66 65 68 0.37 Active smoking 54 54 56 0.95 Dyslipidemia 37 37 35 0.66 Family history 33 34 33 1.00 Diabetes mellitus 25 23 32 0.001 Previous medical history Previous CAD* 29 31 23 0.004 Depression 19 18 22 0.19 Stroke 6.1 5.9 6.6 0.75 Heart failure 5.5 3.2 3.6 0.86 Chronic kidney disease 3.3 6.3 2.7 0.02 Killip III/IV 7 6.9 7.6 0.75 Statistical tests: t-test, Mann-Whitney and chi-square test. Results expressed in %, mean ± standard deviation, and median and 25-75 percentiles. *Previous CAD, acute myocardial infarction or prior myocardial revascularization. CAD: coronary artery disease. Table 2 – Uni- and multivariate analysis of characteristics associated with late presentation Variables OR (95%CI) p value Adjusted OR (95%CI) p value Female gender 1,42 (1,16-1,74) < 0,001 1,13 (0,90-1,42) 0,28 Age 1,00 (0,99-1,01) 0,99 1,00 (0,99-1,01) 0,99 Black ethnicity 1,41 (1,10-1,79) 0,005 1,43 (1,11-1,84) 0,005 Income < 5 minimum wages 1,81 (1,37-2,40) < 0,001 1,60 (1,19-2,15) 0,001 Schooling ≤ 8 years 1,33 (1,08-1,65) 0,007 1,05 (0,84-1,31) 0,66 Depression 1,17 (0,92-1,48) 0,19 1,15 (0,90-1,47) 0,25 Diabetes mellitus 1,42 (1,15-1,74) 0,001 1,37 (1,10-1,71) 0,005 Previous CAD * 0,70 (0,55-0,89) 0,004 0,72 (0,55-0,94) 0,02 Heart failure 0,47 (0,24-0,91) 0,02 0,54 (0,26-1,13) 0,10 * Previous CAD, acute myocardial infarction or prior myocardial revascularization. OR: odds ratio; 95% CI: 95% confidence interval; CAD: coronary artery disease. Most patients with late presentation had lesions in one vessel (48%), 31% had lesions in two vessels and 19% in three vessels – similar rates to those without late presentation (49%, 31% and 18%, respectively; p = 0.72). Table 2 shows the odds ratios of the clinical characteristics and late presentation, before and after adjustment by multiple logistic regression analysis. The independent predictors of late presentation were Black ethnicity, income less than five minimum wages and DM, whereas prior CAD was a protective factor. Figure 1 shows themedian time of presentation in the patients’ subgroups, according to different combinations of predictors of late presentation, showing a large difference in time regarding a certain combination of predictors. For instance, patients with all predictors of late presentation (Black ethnicity, low-income, DM patients, and no previous cardiovascular disease) had the highest median time of presentation, while those with none of the predictors (Caucasian ethnicity, high income, no DM and previous cardiovascular disease) had the lowest median time of presentation (p < 0.001), as shown in figure 1. 589