Impact of prehospital triggers, time of onset, and symptom-to-door time on the prognosis of patients with coronary heart disease.

OBJECTIVE

This study aims to conduct a prehospital registry study on coronary heart disease (CHD) to investigate the effects of prehospital triggers, time of onset, and symptom-to-door time (S2D) on the prognosis of patients with CHD, thereby providing evidence to support early intervention and improve patient outcomes.

METHODS

This study enrolled 600 patients with CHD who were transported by the Emergency Medical Service Center of Chaoyang District, Beijing, between October 2022 and October 2023. The study endpoint was the occurrence of major adverse cardiovascular events (MACE) during a one-year follow-up period. Kaplan-Meier survival curve analysis and multivariable Cox regression were performed. S2D was analyzed as a continuous variable using restricted cubic splines with 4 knots (placed at the 5th, 35th, 65th, and 95th percentiles) to model potential non-linearity.

RESULTS

Among the 600 enrolled CHD patients, 78 (13.0%) reached the primary endpoint. The RCS curve demonstrates a significant non-linear association between S2D and MACE risk (P for non-linearity < 0.001; P for overall < 0.001). Risk increased gradually before 120 min and accelerated thereafter, with an inflection point at approximately 120 min. Multivariable Cox regression identified smoking (HR 1.351, 95% CI 1.062-1.719), hypertension (HR 1.774, 95% CI 1.141-2.757), hypercholesterolemia (HR 1.441, 95% CI 1.118-1.855), diabetes mellitus (HR 1.532, 95% CI 1.314-1.778), emotional stress (HR 1.524, 95% CI 1.284-1.804), symptom onset time between 00:00 a.m. and 05:59 a.m. (HR 1.663, 95% CI 1.122-2.467), and S2D (HR 1.253, 95% CI 1.152-1.363) as independent risk factors for poor prognosis (all p < 0.05).

CONCLUSION

Smoking, hypertension, hypercholesterolemia, diabetes mellitus, emotional stress, symptom onset time between 00:00 a.m. and 05:59 a.m., and S2D are independent risk factors for poor prognosis in patients with CHD. These findings suggest that prehospital assessment of these factors-particularly S2D-could enable early risk stratification and guide timely interventions to improve clinical outcomes.