IJCS | Volume 31, Nº2, March / April 2018

108 common illness (influenza or muscle pain, for instance); lack of knowledge on the benefits of early diagnosis and treatment; and non-availability of standardized extra‑hospital emergency care to all. 5 Previous studies have already shown a correlation between low level of schooling and delay in seeking medical care after chest pain onset. 6 Supposedly, individuals with greater intellectual capacity would be more capable to recognize their symptoms as potentially severe and would seek health care earlier. This study aims to correlate social, educational, cognitive and clinical factors with the time of arrival at the hospital after the onset of AMI first symptoms. Methods This research used the Catherine database Heart Study, a prospective cohort study with registration on ClinicalTrials.gov NCT03015064, which exclusively used its database. Briefly, this is a prospective cohort in which patients from Instituto de Cardiologia de Santa Catarina (ICSC) with a diagnosis of the first AMI are being evaluated. Data have been collected since July 2016, and the study is expected to be completed by December 2020, also intending to include other public hospitals in the State of Santa Catarina. All patients included in the database until December 2016 participated in the current analysis. The inclusion criteria were age older than 18 years; AMI diagnosis established by the presence of suggestive precordial pain, associated with electrocardiogram with a new ST-segment elevation at the J point in two contiguous leads, with limits of ≥ 0.1 mV in all leads, except for leads V2 and V3, to which the limits of ≥0.2mV inmen≥40 years, ≥0.25mV inmen < 40 years and ≥ 0.15 mV in women are applied; or the presence of precordial pain suggestive of AMI associated with elevation in troponin I or creatine kinase MB Isoenzyme (CKMB) levels above the 99 th percentile of the upper reference limit. The exclusion criteria considered for the study were the absence of the established criteria for AMI, presence of previous AMI, and disagreement with the Free and Informed Consent Terms. Data collection was performed through an individual interviewand complementedwith data obtained from the Micromed® electronic medical record. The questionnaire included different clinical and social variables, as well as a specific test for cognitive assessment, the Mini‑Mental State Examination (MMSE), which was applied to all study patients during the length of stay at the institution, usually between the second and the fifth days. Among the social variables, gender, age, marital status, origin and level of schooling were assessed. The clinical variables included the presence of classic risk factors, physical activity, drug and alcohol consumption, and time of symptom onset, among others. Additionally, all study participants are being followed up at 30 days and 1 year, through medical records or by telephone contact, when the records are not available, to assess relevant clinical events such as acute intrastent thrombosis, restenosis, AMI, unstable angina, cerebrovascular accident, bleeding, rehospitalization and death. Such assessments, however, will be addressed in a future study of the Catarina Heart Study. The primary outcome of this study was the correlation between years of schooling with the ∆-T, characterized by the interval between the onset of the first ischemic symptoms and the time of admission at the referral hospital emergency unit, as documented in the electronic medical record. The secondary outcomes were the correlation between ∆-T andMMSE performance, as well as the association between ∆-T and marital status and ∆-T and the presence of classic risk factors for coronary artery disease (systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking, sedentary lifestyle and family history). Statistical analysis For the analytical evaluations, a sample of 92 patients was calculated to find a correlation of 0.3, with 90%power and alpha of 0.05. The obtained data were tabulated and analyzed through the Statistical Package for Social Science (SPSS), version 13.0 for Windows. Continuous variables were expressedasmeanand standarddeviation, ormedian and interquartile range, and evaluated by the two‑tailed Mann-Whitney U test. Normality was assessed by the Kolmogorov-Smirnov test. Age was the only variable that showed a normal distribution and, thus, it was expressed as mean and standard deviation. Variables such as level of schooling, ∆-T and MMSE performance did not show a normal distribution, being expressed as median and interquartile range. Associations between quantitative variables were evaluated by the Kendall correlation, since the correlated variables did not have a parametric distribution. Categorical variables were expressed Takagui et al. Infarction and delay in hospital care Int J Cardiovasc Sci. 2018;31(2)107-113 Original Article