An analysis of the "door to signature" time and its influencing factors in STEMI patients

Objective To investigate the delay of door to signature time in primary percutaneous coronary intervention (PCI) and its influence in patients with ST segment elevation myocardial infarction (STEMI), therefore to provide a scientific basis for further effective shortening the time of primary PCI in patients with STEMI. Methods A total of 226 patients who diagnosed with STEMI and underwent primary PCI at Henan Provincial People's Hospital from June 2016 to December 2017 were enrolled in the study. Observation indicators include: (1) baseline data of patients; (2) time segments in primary PCI: total ischemic time (TIT), door to balloon time (DTΒT), door-to-signature time (DTST), signature to balloon time (STΒT); (3) the demographic characteristics of the family members who signed informed consent; and (4) the psychological factors and coping strategies of family members before signing informed consent. All data was analyzed using SPSS software (version 22.0). Multiple linear regression analysis was used to analyze the influencing factors of delay of DTST. A P<0.05 was considered statistically significant. Results In this study, 226 patients with STEMI who were first diagnosed in our hospital had a mean age of 55.23±10.80 years, and 181 (80.1%) were male. The median of TIT, DTΒT, DTST, STΒT were 312 min, 166 min, 82 min, and 80 min. The ratio of DTST in DTBT and TIT was 50% and 28.5%, respectively. The multiple linear regression analysis showed that the number of direct family members (P<0.001), the degree of educational in middle school and below (P=0.010), high school/technical secondary school (P=0. 029), families worrying about the high cost of medical care (P=0.020), families consulted each other repeatedly (P=0.022), and consulted the other medical staff (P=0.022) are risk factors of DTST delay, and city residence (P=0.048) is the protection factor of DTST delay. Conclusions The long time of DTS is a reality of the practice of primary PCI in China. The factors that lead to longer DTST include demographic characteristics, psychological factors and coping strategies of family members. The STBT of primary PCI in China should be taken into the value while emphasizing the DTBT. Key words: ST segment elevation myocardial infarction; Door-to-signature time; Influence factor