ABSTRACT
Background Although the number of patients presenting with non-ST elevation myocardial infarction (NSTEMI) has drastically reduced in the coronavirus-19 pandemic era, increased mortality was reported. A plausible explanation for increased mortality was suggested as the delay of arrival at the hospital due to patients’ reticence of their symptoms. However, evidence to support the suggested explanation is lacking. Methods From the nationwide prospective registry, we evaluated 6,544 patients with NSTEMI. Study patients were categorized into two groups according to their symptom-to-door (StD) time (<24 h or ≥24 h). The primary outcome was 3-year all-cause mortality, and the secondary outcome was 3-year composite of all-cause mortality, recurrent MI, and hospitalization for heart failure. Results Overall, 27.9% patients were classified into the StD time ≥24 h group. The StD time ≥24 h group had higher all-cause mortality (17.0% vs. 10.5%, p<0.001) and incidence of secondary outcome (23.3% vs. 15.7%, p<0.001) than the StD time <24 h group. In the multivariable analysis, independent predictors of delayed arrival at the hospital were the elderly, female, non-specific symptoms such as atypical chest pain or dyspnea, diabetes, and no use of emergency medical services. Conclusion Delayed arrival (StD time ≥24 h) is associated with an increased risk of 3-year all-cause mortality and composite outcomes in patients with NSTEMI. [Formula presented]