Smoking, hypertension, hypercholesterolemia, diabetes mellitus, emotional stress, symptom onset time between 00:00 a.m. and 05:59 a.m., and symptom-to-door time are independent risk factors for poor prognosis in patients with coronary heart disease.
13% of enrolled CHD patients transported by emergency medical services experienced major adverse cardiovascular events (MACE) during a one-year follow-up period.
Symptom-to-door time (S2D) showed a significant non-linear association with MACE risk, with risk accelerating after an inflection point at approximately 120 minutes.
Emotional stress was identified as an independent prehospital trigger associated with poor prognosis in CHD patients.
Symptom onset between 00:00 a.m. and 05:59 a.m. was an independent risk factor for poor prognosis in CHD patients.
Hypertension was the strongest comorbidity risk factor for poor prognosis among CHD patients, followed by diabetes mellitus, hypercholesterolemia, and smoking.
Kaplan-Meier survival curve analysis and multivariable Cox regression were used to identify independent predictors of MACE in the prehospital CHD registry.
This research suggests that how quickly a coronary heart disease (CHD) patient gets to the hospital after symptoms begin — called symptom-to-door time (S2D) — is a critical factor in whether they will have serious heart-related complications within one year. The study followed 600 CHD patients in Beijing who were brought to the hospital by ambulance, and found that 13% experienced major adverse cardiovascular events (such as heart attack, stroke, or death) during the follow-up year. The relationship between delay time and risk was not straightforward: risk climbed gradually up to about 120 minutes, then accelerated sharply after that point, highlighting 2 hours as a critical threshold. Beyond time-to-hospital, the study identified several other independent risk factors for worse outcomes. Patients who experienced symptoms between midnight and 6 a.m. had a 66% higher risk of poor outcomes compared to other times of day. Emotional stress as a trigger for the cardiac event also significantly raised risk. Traditional risk factors like hypertension, diabetes, high cholesterol, and smoking all independently worsened prognosis, with hypertension showing the strongest effect among comorbidities. This research suggests that prehospital emergency teams could use these factors — especially time from symptom onset to hospital arrival, time of day, and emotional triggers — to rapidly identify which CHD patients are at highest risk and prioritize their care accordingly. The findings reinforce the importance of public awareness campaigns encouraging people to call emergency services immediately when cardiac symptoms begin, since delays beyond two hours appear to substantially worsen outcomes.
Tan X, Wang X, Wang M, Wang J, Liu Y, Gao M, et al.. (2026). Impact of prehospital triggers, time of onset, and symptom-to-door time on the prognosis of patients with coronary heart disease.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1834053