Prevalence and factors related to pre-hospital delay in young patients with ST-elevation myocardial infarction in Perak, Malaysia

ST-Elevation Myocardial Infarction (STEMI) causes a high number of out-of- hospital cardiac arrests, particularly among younger individuals with comorbidities such as diabetes mellitus (DM), hypertension (HPT), hyperlipidaemia, and smoking history. This study aimed to determine the prevalence and factors associated with pre-hospital delays in young STEMI patients. A retrospective study was conducted among patients under the age of 55 based on the list of patients with the diagnosis of STEMI admitted to the Coronary Care Unit (CCU) at Hospital Raja Permaisuri Bainun in Ipoh, Perak between 1st January 2020 and 31st December 2022. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) version 29. The medical records of 340 patients were reviewed. They were predominantly males (93.2%), aged 46-55 (57.1%), and Malays (58.8%). Smoking (69.7%), HPT (43.8%), and DM (34.1%) were the most prevalent comorbidities. Among these patients, the in-hospital mortality rate was 3.2%. The prevalence of pre- hospital delay was 44.7% with a median delay of 7.0 (IQR: 10.34). Patients with DM [OR: 1.72 (95% CI: 1.02, 2.90)], those who “did nothing, hope it will go away” [OR: 3.63 (95% CI: 1.36, 9.69)] or “lay down and tried to relax” [OR: 2.94 (95% CI: 1.43, 6.07)], as well as those whose first medical contact (FMC) was with a general practitioner (GP) [OR: 11.32 (95% CI: 2.20, 58.27)] showed a significant association with prolonged hospital delays (p <0.05). Our study found that nearly half of the patients experienced a pre-hospital delay, with a median delay of 7 hours. This delay was more common among patients with DM, those who attempted to wait for symptoms to subside or self-manage their condition, and those who initially sought treatment from a GP. We recommend public awareness campaigns, especially targeting the young population, to improve early recognition of STEMI symptoms, emphasize the urgency of seeking immediate care, and promote the early detection of risk factors such as diabetes. Enhancing training for GP is crucial to improve early diagnosis, treatment, and referrals.

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