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Original article

Vol. 143 No. 2728 (2013)

Influence of socioeconomic factors on delays, management and outcome amongst patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

  • Stephane Fournier
  • Olivier Muller
  • Andrew J. Ludman
  • Nathalie Lauriers
  • Eric Eeckhout
Cite this as:
Swiss Med Wkly. 2013;143:w13817


AIMS: The outcome after primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) is strongly affected by time delays. In this study, we sought to identify the impact of specific socioeconomic factors on time delays, subsequent STEMI management and outcomes in STEMI patients undergoing pPCI, who came from a well-defined region of the French part of Switzerland.

METHOD AND RESULTS: A total of 402 consecutive patients undergoing pPCI for STEMI in a large tertiary hospital were retrospectively studied. Symptom-to-first-medical-contact time was analysed for the following socioeconomic factors: level of education, origin and marital status. Main exclusion criteria were: time delay beyond 12 hours, previous treatment with fibrinolytic agents or patients immediately referred for coronary artery bypass graft surgery. Therefore, 222 patients were finally included.

At 1 year, there was no difference in mortality between the different socioeconomic groups. Furthermore, there was no difference in management characteristics between them. Symptom-to-first-medical-contact time was significantly longer for patients with a low level of education, Swiss citizens and unmarried patients, with median differences of 23 minutes, 18 minutes and 13 minutes, respectively (p <0.05). Nevertheless, no difference was found regarding in-hospital management and clinical outcome.

CONCLUSION: This study demonstrates that symptom-to-first-medical-contact time is longer amongst people with a lower educational level, Swiss citizens and unmarried people. Because of the low mortality rate in general, these differences in delays did not affect clinical outcomes. Still, tertiary prevention measures should particularly focus on these vulnerable populations.


  1. Wijns W, Kolh P, Danchin N, et al. Guidelines on myocardial revascularization. Eur Heart J. 2010;31(20):2501–55.
  2. Gibson CM. Time is myocardium and time is outcomes. Circulation. 2001;104(22):2632–4.
  3. Gibson CM, de Lemos JA, Antman EM. Time is muscle in primary PCI: the strength of the evidence grows. Eur Heart J. 2004;25(12):1001–2.
  4. De Luca G, van ’t Hof AWJ, de Boer M-J, et al. Time-to-treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty. Eur Heart J. 2004;25(12):1009–13.
  5. Cannon CP, Gibson CM, Lambrew CT, et al. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA. 2000;283(22):2941–7.
  6. Schiele F, Hochadel M, Tubaro M, et al. Reperfusion stategy in Europe: temporal trends in performance measures for reperfusion therapy in ST-elevation myocardial infarction. Eur Heart J. 2010;31(21):2614–24.
  7. Naegeli B, Radovanovic D, Rickli H, et al. Impact of a nationwide public campaign on delays and outcome in Swiss patients with acute coronary syndrome. Eur J Cardiovasc Prev Rehabil. 2011;18(2):297–304.
  8. Berton G, Cordiano R, Palmieri R, et al. Clinical features associated with pre-hospital time delay in acute myocardial infarction. Ital Heart J. 2001;2(10):766–71.
  9. Cohen MG, Fonarow GC, Peterson ED, et al. Racial and ethnic differences in the treatment of acute myocardial infarction: findings from the Get With the Guidelines-Coronary Artery Disease program. Circulation. 2010;121(21):2294–301.
  10. Sheifer SE, Rathore SS, Gersh BJ, et al. Time to presentation with acute myocardial infarction in the elderly: associations with race, sex, and socioeconomic characteristics. Circulation. 2000;102(14):1651–6.
  11. Brown AL, Mann NC, Daya M, et al. Demographic, belief, and situational factors influencing the decision to utilize emergency medical services among chest pain patients. Rapid Early Action for Coronary Treatment (REACT) study. Circulation. 2000;102(2):173–8.
  12. Bradley EH, Herrin J, Wang Y, et al. Racial and ethnic differences in time to acute reperfusion therapy for patients hospitalized with myocardial infarction. JAMA. 2004;292(13):1563–72.
  13. Moser DK, Kimble LP, Alberts MJ, et al. Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart Association Council on cardiovascular nursing and stroke council. Circulation. 2006;114(2):168–82.
  14. Johansson I, Strömberg A, Swahn E. Factors related to delay times in patients with suspected acute myocardial infarction. Heart Lung. 2004;33(5):291–300.
  15. Fang J, Gillespie C, Keenan NL, et al. Awareness of heart attack symptoms among US adults in 2007, and changes in awareness from 2001 to 2007. Future Cardiol. 2011;7(3):311–20.
  16. Byrne M, Murphy AW, Plunkett PK, et al. Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics. Ann Emerg Med. 2003;41(3):309–18.
  17. McGruder HE, Greenlund KJ, Malarcher AM, et al. Racial and ethnic disparities associated with knowledge of symptoms of heart attack and use of 911: National Health Interview Survey, 2001. Ethn Dis. 2008;18(2):192–7.
  18. Hedges JR, Feldman HA, Bittner V, Goldberg RJ, Zapka J, Osganian SK, et al. Impact of community intervention to reduce patient delay time on use of reperfusion therapy for acute myocardial infarction: rapid early action for coronary treatment (REACT) trial. REACT Study Group. Acad Emerg Med. 2000;7(8):862–72.
  19. Cricri P, Trachsel L, Müller P, Wäckerlin A, Reinhart W, Bonetti P. Incidence and time frame of life-threatening arrhythmias in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Swiss Med Wkly. 2012;142:w13604.

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