Background: Acute coronary syndrome (ACS) is currently the leading cause of morbidity and mortality worldwide. The prognosis of ACS treatment outcome depends on the speed of reperfusion after a heart attack; wherein, one of the associated factors is pre-hospital time.
Method: A retrospective study was conducted in ACS patients, who visited the emergency room of a tertiary hospital; from 1st January to 31st December 2020. The primary outcome was pre-hospital time; and secondary outcome was factors associated with delayed pre-hospital time (≥ 2 hours) that were analyzed by using logistic regression.
Results: The Median age of patients was 64 years (Q1, Q3 = 56, 73), with 75.8% being male. The median pre-hospital time was 2.5 hours (Q1, Q3 = 1.0, 6.0), 63.4% of acute coronary events were delayed pre-hospital time, and 90.1% of events were transported to the hospital by private car. The factors significantly associated with delayed pre-hospital time consisted of adult patients [OR (95%CI) = 2.20 (1.05 - 4.61)], events occurring on weekdays [OR (95%CI) = 2.08 (1.04 - 4.14)] and inside their home [OR (95%CI) = 5.01 (1.67 - 15.06)], final diagnosis with NSTEMI [OR (95%CI) = 2.74 (1.24 - 6.05)], and taking isosorbide in previously diagnosed MI patients [OR (95%CI) = 4.32 (1.42 - 13.17)].
Conclusion: Patients with ACS still delayed seeking treatment, and underutilized emergency medical service systems. Interventions to increase awareness and knowledge of ACS is required to improve the treatment outcomes of ACS patients.
Keywords: acute coronary syndrome, myocardial infarction, pre-hospital time
Ananchaisarp T, Tantarattanapong S, Satayukun S,
Delayed pre-hospital time in acute coronary syndrome patients and associated factors in a hospital in Southern Thailand.
J Health Res.
 World Health Organization. The top 10 causes of death [Internet] [cited 2021 Mar 25]. Available at: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-ofdeath#:~:text¼The%20top%20global%20causes%20of,birth%20asphyxia%20and%20birth%20trauma%2C.
 The heart association of Thailand under the royal patronage of H.M. The king. Thai ACS guidelines 2020 [Internet]. [cited 2021 Mar 29]. Available from: http://www.thaiheart.org/Thai-ACS-Guidelines-2020.
 Moser DK, Kimble LP, Alberts MJ, Alonzo A, Croft JB, Dracup K, 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;114:168-82.
 Tantisiriwat W, Jiar W, Ngamkasem H, Tantisiriwat S. Clinical outcomes of fast track managed care system for acute ST elevation myocardial infarction (STEMI) patients: chonburi Hospital experience. J Med Assoc Thai 2008;91:822-7.
 Rafi A, Sayeed Z, Sultana P, Aik S, Hossain G. Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh. BMC Health Serv Res 2020;20:633.
 Park YH, Kang GH, Song BG, Chun WJ, Lee JH, Hwang SY, et al. Factors related to prehospital time delay in acute STsegment elevation myocardial infarction. J Kor Med Sci 2012; 27:864.
 Song L, Yan HB, Yang JG, Sun YH, Hu DY. Impact of patients' symptom interpretation on care-seeking behaviors of patients with acute myocardial infarction. Chin Med J 2010; 123:1840-5.
 McKinley S, Aitken LM, Marshall AP, Buckley T, Baker H, Davidson PM, et al. Delays in presentation with acute coronary syndrome in people with coronary artery disease in Australia and New Zealand: Australian and New Zealand delay in ACS. Emerg Med Australasia (EMA) 2011;23: 153-61.
 Lim SC, Rahman A, Yaacob NM. Pre-hospital factors influencing time of arrival at emergency departments for patients with acute ST-elevation myocardial infarction. Malays J Med Sci 2019;26:87-98. https://doi.org/10.21315/mjms2019.26.1.8.
 Perrin N, Iglesias JF, Rey F, Benzakour L, Cimci M, Noble S, et al. Impact of the COVID-19 pandemic on acute coronary syndromes. Swiss Med Wkly 2020 Dec 14;150:w20448.
 Goldberg RJ, Spencer FA, Fox KA, Brieger D, Steg PG, Gurfinkel E, et al. Prehospital delay in patients with acute coronary syndromes (from the global registry of acute coronary events [GRACE]). Am J Cardiol 2009;103:598-603. https://doi.org/10.1016/j.amjcard.2008.10.038.
 Berton G, Cordiano R, Palmieri R, Guarnieri G, Stefani M, Palatini P. Clinical features associated with pre-hospital time delay in acute myocardial infarction. Ital Heart J 2001;2: 766-71.
 Sari I, Acar Z, Ozer O, Erer B, Tekbas E, Uçer E, et al. Factors associated with prolonged prehospital delay in patients with acute myocardial infarction. Turk Kardiyol Dernegi Arsivi 2008;36:156-62.
 Goff DC, Feldman HA, McGovern PG, Goldberg RJ, SimonsMorton DG, Cornell CE, et al. Prehospital delay in patients hospitalized with heart attack symptoms in the United States: the REACT trial. Am Heart J 1999;138:1046-57.
 Lee SH, Kim HK, Jeong MH, Lee JM, Gwon H-C, Chae SC, et al. Pre-hospital delay and emergency medical services in acute myocardial infarction. Korean J Intern Med 2020;35: 119-32.
 George L, Ramamoorthy L, Satheesh S, Saya R, Subrahmanyam DKS. Prehospital delay and time to reperfusion therapy in ST elevation myocardial infarction. J Emergencies, Trauma, Shock 2017;10:64.
 Mirzaei S, Steffen A, Vuckovic K, Ryan C, Bronas UG, ZegreHemsey J, et al. The association between symptom onset characteristics and prehospital delay in women and men with acute coronary syndrome. Eur J Cardiovasc Nurs 2020; 19:142-54.
 Perkins-Porras L, Whitehead DL, Strike PC, Steptoe A. Prehospital delay in patients with acute coronary syndrome: factors associated with patient decision time and home-tohospital delay. Eur J Cardiovasc Nurs 2009;8:26-33. https://doi.org/10.1016/j.ejcnurse.2008.05.001.
 Pimpukdee W. Factors predicting pre-hospital time in patients with acute coronary syndrome [Dissertation]. Bangkok: Chulalongkorn University; 2009.
 Morris PD, Channer KS. Testosterone and cardiovascular disease in men. Asian J Androl 2012;14:428-35.