The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Factors Influencing Delay in Symptom-to-Door Time in Patients with Acute ST-Segment Elevation Myocardial Infarction

ST분절 상승 심근경색증 환자에서 증상 발생 후 응급센터 도착 시간 지연에 영향을 주는 요인

  • Lee, Jae Hoon (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Jeong, Myung Ho (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Rhee, Jung Ae (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Choi, Jin Su (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Park, In Hyae (Nursing Department of Chonnam National University) ;
  • Chai, Leem Soon (Gwangju Christian College of Nursing) ;
  • Jang, Soo Yong (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Cho, Jae Young (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Jeong, Hae Chang (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Lee, Ki Hong (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Park, Keun-Ho (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Sim, Doo Sun (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Kim, Kye Hun (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Hong, Young Joon (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Park, Hyung Wook (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea) ;
  • Kim, Ju Han (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Ahn, Young keun (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Cho, Jeong Gwan (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Park, Jong Chun (The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School)
  • 이재훈 (전남대학교병원 심장센터) ;
  • 정명호 (전남대학교병원 심장센터) ;
  • 이정애 (전남대학교 의과대학 예방의학교실) ;
  • 최진수 (전남대학교 의과대학 예방의학교실) ;
  • 박인혜 (전남대학교 간호대학) ;
  • 채임순 (광주기독 간호대학) ;
  • 장수영 (전남대학교병원 심장센터) ;
  • 조재영 (전남대학교병원 심장센터) ;
  • 정해창 (전남대학교병원 심장센터) ;
  • 이기홍 (전남대학교병원 심장센터) ;
  • 박근호 (전남대학교병원 심장센터) ;
  • 심두선 (전남대학교병원 심장센터) ;
  • 김계훈 (전남대학교병원 심장센터) ;
  • 홍영준 (전남대학교병원 심장센터) ;
  • 박형욱 ;
  • 김주한 (전남대학교병원 심장센터) ;
  • 안영근 (전남대학교병원 심장센터) ;
  • 조정관 (전남대학교병원 심장센터) ;
  • 박종춘 (전남대학교병원 심장센터)
  • Received : 2013.10.07
  • Accepted : 2014.05.03
  • Published : 2014.10.01
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Abstract

Background/Aims: Delay in symptom-to-door time (SDT) in patients with acute ST-segment elevation myocardial infarction (STEMI) is the most important factor in the prediction of short and long-term mortality. The purpose of this study was to investigate the social and clinical factors affecting SDT in patients with STEMI. Methods: We analyzed 784 patients ($61.0{\pm}13.2$ years, 603 male) diagnosed with STEMI from November 2005 to February 2012. The patients were divided into four groups according to SDT: Group I (n = 163, ${\leq}1$ h), Group II (n = 183, 1-2 h), Group III (n = 142, 2-3 h) and Group IV (n = 296, > 3 h). Results: Delay in SDT increased with age (Group I, $58.4{\pm}12.0$; Group II, $59.4{\pm}13.3$; Group III, $62.0{\pm}12.8$; Group IV, $63.0{\pm}13.8$ years, p = 0.001). In 119 patients, transportation was less frequently used as the delay in SDT (41.7% vs. 29.0% vs. 26.1% vs. 9.8%, p < 0.001). By multiple logistic regression analysis, family history [OR, 0.488; CI, 0.248-0.959; p = 0.037], previous ischemic heart disease [OR, 0.572; CI, 0.331-0.989; p = 0.045], no occupation [OR, 1.600; CI, 1.076-2.380; p = 0.020] and method of transportation [OR, 0.353; CI, 0.239-0.520; p < 0.001] were independent predictors of delay in SDT. Conclusions: Our study shows that general education about cardiovascular symptoms and a prompt emergency call could be important to reduce SDT in STEMI.

목적: 급성 ST분절 상승 심근경색증(ST elevation myocardial infarction, STEMI) 환자에서 증상 발생 후 응급실 도착 지연은 단기 및 장기 사망률에 영향을 미치는 중요한 요소이다. 본 연구는 ST분 절 상승 심근경색증 환자에서 증상 발생 후 응급실 도착(symptom to door time, SDT) 지연에 영향을 미치는 사회적, 임상적 요인을 알아보고자 한다. 방법: 2005년 11월부터 2012년 2월까지 전남대학교병원에 내원한 STEMI 환자 784명(평균 연령 $61.0{\pm}13.2$세, 남자 603명)을 분석하였다. SDT가 1시간 이내를 I군, 1시간 초과 2시간 이내를 II군, 2시간 초과 3시간 이내를 III군, 3시간 초과를 IV군으로 나누었다. 결과: SDT가 지연될수록 나이가 유의하게 많아졌고($58.4{\pm}12.0$ vs. $59.4{\pm}13.3$ vs $62.0{\pm}12.8$ vs $63.0{\pm}13.8$세, p = 0.001), 여성 비율이 많았다(16.6 vs. 18.6 vs. 21.1 vs. 31.0%, p < 0.001). 허혈성 심장 질환 과거력 환자에서 다른 군보다 I군의 비율이 유의하게 많았다(19.8 vs. 7.7 vs. 9.2 vs. 8.4%, p = 0.003). SDT가 지연될수록 체형지수가 0.8초과인 비율이 유의하게 많아지는 경향이 보였고(45.2 vs. 52.6 vs. 51.7 vs. 63.4%, p < 0.001), SDT가 지연될수록 교육 정도 6년 이하 비율이 유의하게 많았고(14.6 vs. 19.4 vs. 27.8 vs. 36.3%, p < 0.001), 직업이 없는 비율이 유의하게 많았다(40.1 vs. 39.5 vs. 54.3 vs. 56.9%, p < 0.001). 그리고 내원 방법에서 SDT가 지연될수록 119를 이용하는 비율이 유의하게 적었다(41.7 vs. 29.0 vs. 26.1 vs. 9.8%, p < 0.001). 다변량 로지스틱 회귀분석에서 가족력[OR, 0.488; CI, 0.248-0.959; p = 0.037], 허혈성 심장 질환 과거력[OR, 0.572; CI, 0.331-0.989; p = 0.045], 무직[OR, 1.600; CI, 1.076-2.380; p = 0.020], 내원 방법[OR, 0.353; CI, 0.239-0.520; p < 0.001]이 SDT 지연의 독립적인 예측인자였다. 결론: 급성 심근경색증 증상의 인식에 대한 교육과 급성 심근경색증 증상 발생 후 119를 통한 신속한 이송이 STEMI 환자에서 SDT을 줄일 수 있는 중요한 인자임을 알 수 있었다.

Keywords

References

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