Pre-hospital delay and emergency medical services in acute myocardial infarction

KAMIR Investigators

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Background/Aims: Minimising total ischemic time (TIT) is important for improving clinical outcomes in patients with ST-segment elevation myocardial infarction who have undergone percutaneous coronary intervention (PCI). TIT has not shown a significant improvement due to persistent pre-hospital delay. This study aimed to investigate the risk factors associated with pre-hospital delay. Methods: Individuals enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health between 2011 and 2015 were included in this study. The study population was analyzed according to the symptom-to-door time (STDT; within 60 or > 60 minutes), and according to the type of hospital visit (emergency medical services [EMS], non-PCI center, or PCI center). Results: A total of 4,874 patients were included in the analysis, of whom 28.4% arrived at the hospital within 60 minutes of symptom-onset. Old age (> 65 years), female gender, and renewed ischemia were independent predictors of delayed STDT. Utilising EMS was the only factor shown to reduce STDT within 60 minutes, even when cardiogenic shock was evident. The overall frequency of EMS utilisation was low (21.7%). Female gender was associated with not utilising EMS, whereas cardiogenic shock, previous myocardial infarction, familial history of ischemic heart disease, and off-hour visits were associated with utilising EMS. Conclusions: Factors associated with delayed STDT and not utilising EMS could be targets for preventive intervention to improve STDT and TIT.

Original languageEnglish
Pages (from-to)119-132
Number of pages14
JournalKorean Journal of Internal Medicine
Issue number1
Publication statusPublished - 2020

Bibliographical note

Funding Information:
The authors thank the clinical investigators of the Korea Acute Myocardial Infarction Registry who contributed their time and effort to this study. This research was supported by a grant from the Research of Korea Centers for Disease Control and Prevention (2016-ER6304-01). This study was supported by research fund from Chosun University, 2016.

Publisher Copyright:
© Korean Association of Internal Medicine. All rights reserved.


  • Cardiogenic shock
  • Emergency medical services
  • Myocardial infarction
  • Prognosis
  • Time factors

ASJC Scopus subject areas

  • Internal Medicine


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