Table 5.
Patient Characteristics According to Extent of Prehospital Delay
| Characteristic | Age, y | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ≥65 | 65 to 74 | 75 to 84 | ≥85 | |||||||||
| Delay, Hours | <2 (n=720) | ≥2 (n=822) | P Value | <2 (n=269) | ≥2 (n=280) | P Value | <2 (n=293) | ≥2 (n=375) | P Value | <2 (n=158) | ≥2 (n=167) | P Value |
| Demographics | ||||||||||||
| Age, mean (y) | 77.9 | 78.1 | 0.74 | 69.5 | 69.6 | 0.61 | 79.7 | 79.8 | 0.74 | 89.0 | 88.3 | 0.07 |
| Female (%) | 45.0 | 46.6 | 0.53 | 31.6 | 36.4 | 0.23 | 49.8 | 47.2 | 0.50 | 58.9 | 62.3 | 0.53 |
| White (%) | 91.9 | 90.7 | 0.43 | 89.1 | 86.4 | 0.38 | 92.0 | 92.1 | 0.97 | 96.0 | 94.2 | 0.49 |
| Body mass index ≥30 (%) | 25.3 | 26.2 | 0.43 | 37.6 | 36.7 | 0.93 | 20.8 | 23.6 | 0.23 | 10.7 | 14.0 | 0.70 |
| DNR order (%) | 25.4 | 26.8 | 0.54 | 8.2 | 11.1 | 0.25 | 22.5 | 26.9 | 0.19 | 60.1 | 52.7 | 0.18 |
| Marital status (%) | ||||||||||||
| Single | 9.7 | 8.6 | 10.5 | 9.0 | 7.3 | 7.5 | 12.7 | 10.2 | ||||
| Married | 52.7 | 53.1 | 0.40 | 62.3 | 64.6 | 0.60 | 54.5 | 53.8 | 0.52 | 32.9 | 32.3 | 0.25 |
| Divorced | 7.3 | 5.3 | 11.2 | 10.1 | 6.3 | 3.8 | 2.5 | 0.6 | ||||
| Widowed | 29.3 | 32.1 | 14.6 | 15.9 | 30.9 | 34.4 | 51.3 | 53.9 | ||||
| Medical history (%) | ||||||||||||
| Angina | 22.8 | 19.1 | 0.08 | 21.6 | 15.4 | 0.06 | 20.8 | 20.5 | 0.93 | 28.5 | 22.2 | 0.19 |
| Atrial fibrillation | 18.3 | 18.0 | 0.87 | 10.0 | 10.0 | 0.99 | 22.2 | 19.5 | 0.39 | 25.3 | 28.1 | 0.56 |
| Diabetes | 36.0 | 37.2 | 0.61 | 36.8 | 46.8 | <0.05 | 38.9 | 34.7 | 0.26 | 29.1 | 27.0 | 0.66 |
| Heart failure | 28.2 | 27.9 | 0.88 | 16.0 | 22.9 | <0.05 | 32.4 | 27.7 | 0.19 | 41.1 | 36.5 | 0.39 |
| Hypertension | 82.5 | 81.1 | 0.49 | 80.7 | 78.2 | 0.48 | 82.6 | 81.3 | 0.67 | 85.4 | 85.6 | 0.96 |
| Stroke | 13.5 | 13.0 | 0.79 | 7.1 | 13.2 | <0.05 | 16.7 | 13.6 | 0.26 | 18.4 | 11.4 | 0.08 |
| Insurance status (%) | ||||||||||||
| Medicare | 49.4 | 44.8 | 0.32 | 39.9 | 40.0 | 0.32 | 54.1 | 44.4 | 0.12 | 56.7 | 53.9 | 0.95 |
| HMO | 38.2 | 43.5 | 41.0 | 47.1 | 37.7 | 44.1 | 34.2 | 35.9 | ||||
| Medicaid | 1.0 | 0.9 | 2.2 | 1.1 | 0.3 | 1.1 | 0 | 0 | ||||
| Blue Cross/private insurance | 9.1 | 8.9 | 12.7 | 8.9 | 6.5 | 9.1 | 7.7 | 8.4 | ||||
| Private payment/other | 2.4 | 2.0 | 4.1 | 2.9 | 1.4 | 1.3 | 1.3 | 1.8 | ||||
| Ambulance transportation (%) | 78.1 | 74.0 | 0.31 | 68.3 | 65.0 | 0.45 | 80.2 | 73.3 | <0.05 | 89.2 | 89.2 | 1.0 |
| Type of AMI (%) | ||||||||||||
| NSTEMI | 63.6 | 70.2 | <0.01 | 55.0 | 66.1 | <0.01 | 65.5 | 69.1 | 0.33 | 74.7 | 79.6 | 0.28 |
| Presenting symptoms (%) | ||||||||||||
| Abdominal pain | 6.0 | 8.5 | 0.05 | 4.1 | 6.1 | 0.29 | 6.5 | 9.1 | 0.22 | 8.2 | 11.4 | 0.34 |
| Chest pain | 80.7 | 83.1 | 0.22 | 85.9 | 87.5 | 0.57 | 80.9 | 82.7 | 0.55 | 71.5 | 76.7 | 0.29 |
| Diaphoresis | 35.7 | 32.5 | 0.18 | 41.3 | 35.4 | 0.15 | 34.1 | 31.5 | 0.46 | 29.1 | 29.9 | 0.87 |
| Fatigue | 12.8 | 15.0 | 0.22 | 13.4 | 13.2 | 0.95 | 8.9 | 16.0 | <0.01 | 19.0 | 15.6 | 0.41 |
| Nausea | 30.0 | 32.9 | 0.23 | 35.7 | 37.1 | 0.72 | 25.9 | 28.8 | 0.41 | 27.9 | 34.7 | 0.18 |
| Palpitations | 6.5 | 9.4 | <0.05 | 8.2 | 10.0 | 0.46 | 5.8 | 8.3 | 0.22 | 5.1 | 10.8 | 0.05 |
| Shortness of breath | 55.1 | 57.4 | 0.37 | 57.9 | 52.4 | 0.2 | 55.0 | 57.1 | 0.58 | 60.1 | 57.5 | 0.63 |
| Medication and procedure history (%) | ||||||||||||
| Aspirin | 52.6 | 53.2 | 0.84 | 49.4 | 51.1 | 0.70 | 52.6 | 55.2 | 0.50 | 58.2 | 52.1 | 0.27 |
| Beta‐blockers | 52.8 | 56.5 | 0.15 | 53.5 | 51.1 | 0.56 | 52.2 | 57.3 | 0.19 | 52.5 | 63.5 | <0.05 |
| Lipid‐lowering agents | 46.1 | 47.2 | 0.67 | 52.8 | 51.4 | 0.75 | 47.4 | 47.7 | 0.94 | 32.3 | 38.9 | 0.21 |
| ACE inhibitors/ARBs | 46.3 | 45.3 | 0.70 | 45.7 | 45.7 | 1.0 | 47.4 | 44.0 | 0.38 | 44.9 | 47.3 | 0.67 |
| PCI | 22.8 | 23.4 | 0.79 | 28.3 | 26.4 | 0.63 | 21.5 | 24.0 | 0.45 | 15.8 | 16.8 | 0.82 |
| CABG surgery | 15.8 | 18.4 | 0.19 | 16.4 | 21.4 | 0.13 | 17.1 | 18.7 | 0.59 | 12.7 | 12.6 | 0.98 |
| Acute symptom onset (%) | ||||||||||||
| 12 am to 6 am | 25.3 | 28.0 | 24.9 | 29.4 | 22.4 | 26.0 | 30.7 | 29.9 | ||||
| 6 am to 12 pm | 30.1 | 24.4 | 28.0 | 23.5 | 29.7 | 25.0 | 33.6 | 24.5 | ||||
| 12 pm to 6 pm | 22.0 | 19.7 | 25.9 | 22.6 | 22.8 | 18.7 | 15.3 | 17.7 | ||||
| 6 pm to 12 am | 22.6 | 28.0 | <0.05 | 21.2 | 24.5 | 0.48 | 25.0 | 30.3 | 0.24 | 20.4 | 27.9 | 0.27 |
| ER weekend visit (%) | 27.6 | 26.6 | 0.66 | 27.5 | 25.7 | 0.63 | 27.2 | 25.3 | 0.57 | 32.3 | 27.0 | 0.29 |
| Hospital vital signs, mean | ||||||||||||
| Diastolic blood pressure, mm Hg | 76.3 | 76.7 | 0.69 | 79.9 | 79.2 | 0.68 | 75.9 | 77.4 | 0.33 | 70.7 | 70.8 | 0.96 |
| Heart rate, bpm | 86.4 | 86.3 | 0.91 | 83.5 | 84.8 | 0.47 | 86.2 | 86.9 | 0.72 | 92.0 | 87.5 | 0.09 |
| Systolic blood pressure, mm Hg | 143.2 | 145.8 | 0.12 | 146.0 | 146.1 | 0.97 | 142.8 | 146.5 | 0.14 | 139.2 | 143.7 | 0.22 |
| Admission laboratory findings, mean | ||||||||||||
| Cholesterol | 164.6 | 167.3 | 0.34 | 168.0 | 168.0 | 0.98 | 160.1 | 164.3 | 0.32 | 166.2 | 173.4 | 0.31 |
| eGFR | 53.5 | 53.7 | 0.84 | 60.6 | 57.5 | 0.07 | 50.4 | 54.4 | <0.01 | 47.5 | 45.9 | 0.44 |
| Glucose | 176.6 | 179.0 | 0.55 | 175.1 | 180.9 | 0.40 | 176.4 | 174.2 | 0.70 | 179.5 | 186.4 | 0.43 |
| STEMI (%) | 36.4 | 29.8 | <0.01 | 45.0 | 33.9 | <0.01 | 34.5 | 30.9 | 0.33 | 25.3 | 20.4 | 0.29 |
| Early hospital complications | ||||||||||||
| Atrial fibrillation | 16.0 | 17.9 | 0.32 | 11.2 | 11.4 | 0.92 | 17.8 | 18.1 | 0.90 | 20.9 | 28.1 | 0.13 |
| Cardiac arrest | 3.6 | 1.7 | 0.01 | 4.1 | 2.5 | 0.29 | 3.8 | 0.8 | <0.01 | 2.5 | 2.4 | 0.94 |
| Cardiogenic shock | 5.4 | 2.2 | <0.01 | 6.3 | 2.9 | 0.05 | 4.4 | 2.1 | 0.09 | 5.7 | 1.2 | <0.05 |
| Heart failure | 28.9 | 33.3 | 0.06 | 21.9 | 28.6 | 0.07 | 32.1 | 33.6 | 0.68 | 34.8 | 40.7 | 0.27 |
| Stroke | 0.6 | 0.7 | 0.67 | 0.7 | 0.4 | 0.54 | 0.7 | 0.3 | 0.43 | 0.0 | 2.4 | <0.05 |
| Ventricular fibrillation | 2.6 | 2.0 | 0.36 | 4.5 | 3.2 | 0.45 | 2.4 | 1.6 | 0.47 | 0.0 | 0.6 | 0.25 |
| Death (%) | 8.8 | 8.5 | 0.87 | 4.8 | 6.8 | 0.33 | 9.9 | 8.3 | 0.47 | 13.3 | 12.0 | 0.72 |
| Hospital length of stay, mean (days) | 5.5 | 5.2 | 0.28 | 5.4 | 5.1 | 0.30 | 5.9 | 5.5 | 0.35 | 4.8 | 4.9 | 0.84 |
ACE indicates angiotensin‐converting enzyme; AMI, acute myocardial infarction; ARBs, angiotensin receptor blockers; CABG, coronary artery bypass graft; DNR, do‐not‐resuscitate; eGFR, estimated glomerular filtration rate; ER, emergency room; HMO, health maintenance organization; NSTEMI, non‐ST‐elevation myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST‐elevation myocardial infarction.