Pre-Hospital Delay and Factors Associated With Delayed Presentation Among Patients With ST-Segment Elevation Myocardial Infarction in Peshawar: A Cross-Sectional Study

Abstract

Objectives: To determine the frequency of pre-hospital delay and identify factors independently associated with delayed presentation among patients with ST-segment elevation myocardial infarction (STEMI) presenting to a tertiary cardiac care center in Peshawar, Pakistan. Methodology: This analytical cross-sectional study included a total of 255 consecutive adults with confirmed STEMI. Data were collected using a structured, pilot-tested pro forma covering sociodemographic characteristics, symptom interpretation, healthcare-seeking behavior, first medical contact, geographic distance, and symptom-onset-to-Coronary Care Unit (CCU)-arrival time. Pre-hospital delay was operationally defined as a symptom-onset-to-CCU-arrival interval >6 hours; this composite interval could include both patient-related and healthcare-system/referral-related components. Results: The mean age of the 255 participants was 59.93 ± 10.57 years, and 133 (52.2%) were female. The median symptom-onset-to-CCU-arrival time was 5.0 hours (IQR: 2.5–9.5), and 123 (48.2%) participants presented >6 hours after symptom onset. After multivariable adjustment, increasing age was associated with greater odds of delay (aOR=1.19 per year; 95% CI: 1.12–1.27; p<0.001), whereas male gender was associated with substantially lower odds compared with female gender (aOR=0.03; 95% CI: 0.01–0.10; p<0.001). Musculoskeletal rather than gastrointestinal symptom misinterpretation (aOR=8.42; 95% CI: 2.94–24.10; p<0.001), misguided healthcare-seeking behavior (aOR=11.18; 95% CI: 4.46–28.02; p<0.001), and first medical contact with a local hospital rather than a cardiac care center (aOR=14.67; 95% CI: 5.42–39.69; p<0.001) were associated with greater odds of delayed presentation. Intermediate versus remote distance was associated with lower odds of delay (aOR=0.09; 95% CI: 0.03–0.27; p<0.001). Educational level, urban/rural residence, economic status, and proximate versus remote distance were not independently associated with delay. Conclusion: Nearly half of the patients with STEMI presented to definitive cardiac care more than six hours after symptom onset. Delayed presentation was associated with older age, female gender, musculoskeletal symptom misinterpretation, misguided healthcare-seeking behavior, and initial contact with a local non-cardiac facility.