Evidence map›Paper›PMID 36396304›Full record

Observational studyBMJ open2022

In-depth look into urban and rural disparities in prehospital delay in patients with acute ST-elevation myocardial infarction and its impact on prognosis: a prospective observational study.

Changxian Shen, Chengzong Li, Jin Wang, Jianrong Yin, Peian Lou, Zhirong Wang, Yuan Lu, Yu Yang, Mingfang Li, Minglong Chen

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Changxian ShenDepartment of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Chengzong LiDepartment of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Jin WangDepartment of Chest Pain Center, The Pizhou Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Jianrong YinDepartment of Cardiology, The Pizhou Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Peian LouDepartment of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou, China.
Zhirong WangDepartment of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Yuan LuDepartment of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Yu YangDepartment of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Mingfang LiDepartment of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Minglong ChenDepartment of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China chenminglong2001@163.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesIn line with the cardiac fast track, the 'green pathway for patients with heart attack' policy in China is implemented to reduce door-to-balloon time in patients with ST-segment elevation myocardial infarction (STEMI). However, the difference in prehospital delay between urban and rural areas of China and its impact on prognosis is unclear.

designProspective observational study.

settingThis study was conducted in a tertiary hospital, the only nationally accredited chest pain centre with percutaneous coronary intervention (PCI) capacity in Pizhou, China.

participants394 patients with STEMI without patients with in-hospital STEMI or patients lost to follow-up were included. PRIMARY OUTCOME MEASURES: Primary outcome was major adverse cardiovascular events (MACEs), including cardiac death, non-fatal myocardial infarction and heart failure.

resultsAmong 394 patients enrolled, 261 (66.2%) were men, the median age was 69 years (interquartile range: 61-77 years), and 269 (68.3%) were from rural areas. Symptom-to-door (S2D) time was significantly longer for rural patients than for urban patients (p<0.001). Cox regression analyses revealed living in rural areas was independently associated with prolonged S2D time (adjusted HR 0.59; 95% CI 0.43 to 0.81; p=0.001). HR of <1 indicates that the S2D time is longer for patients in the rural group (group of interest). During 1-year follow-up, the incidence of MACEs was higher in rural patients (p=0.008). The unadjusted OR for MACEs between rural and urban patients was 2.22 (95% CI 1.22 to 4.01). Adjusting for sex did not attenuate the association (OR 2.06; 95% CI 1.13 to 3.76), but after further adjusting for age, cardiac function classification, S2D time and performance of primary PCI, we found that odds were similar for rural and urban patients (OR 1.19; 95% CI 0.59 to 2.38).

conclusionsRural patients with STEMI had a longer S2D time, which led to a higher incidence of MACEs. This study provides rationales for taking all the measures to avoid prehospital delay.

Indexed as

Emergency Medical ServicesMyocardial InfarctionPercutaneous Coronary InterventionST Elevation Myocardial InfarctionAgedFemaleHumansMaleTime FactorsCoronary heart diseaseCoronary interventionMyocardial infarction

Identifiers

PMID36396304
PMCPMC9677036

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