Pre-hospital delay in patients with acute myocardial infarction in China:findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS)project

OBJECTIVE To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction(AMI)in China.METHODS Data were collected from November 2014 to December 2019 as part of the Improving Care for Cardiovascular Dis-ease in China-Acute Coronary Syndrome(CCC-ACS)project.A total of 33,386 patients with AMI admitted to the index hospitals were included in this study.Two-level logistic regression was conducted to explore the factors associated with the pre-hospital delay and the associations between different pre-hospital delay and in-hospital outcomes.RESULTS Of the 33,386 patients with AMI,70.7%of patients arrived at hospital≥2 h after symptom onset.Old age,female,ru-ral medical insurance,symptom onset at early dawn,and non-use of an ambulance predicted a prolonged pre-hospital delay(all P<0.05).Hypertension and heart failure at admission were only significant in predicting a longer delay in patients with ST-seg-ment elevation myocardial infarction(STEMI)(all P<0.05).A pre-hospital delay of≥2 h was associated with an increased risk of mortality[odds ratio(OR)=1.36,95%CI:1.09-1.69,P=0.006]and major adverse cardiovascular events(OR=1.22,95%CI:1.02-1.47,P=0.033)in patients with STEMI compared with a pre-hospital delay of<2 h.CONCLUSIONS Prolonged pre-hospital delay is associated with adverse in-hospital outcomes in patients with STEMI in China.Our study identifies that patient characteristics,symptom onset time,and type of transportation are associated with pre-hospital delay time,and provides focuses for quality improvement.

Identification of two novel GATA6 mutations in an adult with acute myocardial infarction, diabetes, and atrial fibrillation: a case report

With the aging of the world’s population, the incidence of coronary atherosclerotic disease (CAD) is gradually increasing, which places a heavy burden on social development.[ 1] Acute myocardial infarction (AMI) is the most serious stage in the development of CAD and can lead to cardiac arrest.

Depression and myocardial injury in ST-segment elevation myocardial infarction:A cardiac magnetic resonance imaging study

BACKGROUND Depression is common in patients with myocardial infarction and has been independently associated with adverse outcomes.However,the association between depression and myocardial injury on cardiac magnetic resonance(CMR)in patients with ST-segment elevation myocardial infarction(STEMI)has still not been assessed.AIM To assess the association between depression and myocardial injury on CMR in patients with STEMI.METHODS A total of 107 STEMI patients undergoing primary percutaneous coronary intervention(P-PCI)were analyzed in this prospectivecohort study.Each subject completed the Patient Health Questionnaire-9(PHQ-9)to assess the presence and severity of depressive symptoms.CMR was performed at a median of 3 d after PPCI for quantifying post-MI myocardial injury.Correlations between depression identified by the PHQ-9 and myocardial injury measured on CMR were assessed.RESULTS In this study,19 patients(17.8%)were diagnosed with major depression identified by the PHQ-9≥10.PHQ-9 was analyzed both as a continuous variable and dichotomous variable.After multivariable adjustment,the proportion of patients with large infarction size was significantly higher in the major depression group(PHQ-9≥10)(OR:4.840,95%CI:1.122–20.868,P=0.034).When the PHQ-9 was evaluated as a continuous variable,after multivariable adjustment,an increased PHQ-9 score was associated with an increased risk of large infarction size(OR:1.226,95%CI:1.073–1.401,P=0.003).CONCLUSION In patients with STEMI undergoing PCI,depression was independently associated with a large infarction size.