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

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Title: Impact of prehospital triggers, time of onset, and symptom-to-door time on the prognosis of patients with coronary heart disease.
Authors: Tan X; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China., Wang X; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China., Wang M; Department of Cardiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China., Wang J; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China., Liu Y; Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China., Gao M; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China., Pan Y; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China., Chen M; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China., Zhang C; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
Source: Frontiers in public health [Front Public Health] 2026 Aug 10; Vol. 14, pp. 1834053. Date of Electronic Publication: 2026 Aug 10 (Print Publication: 2026).
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Frontiers Editorial Office Country of Publication: Switzerland NLM ID: 101616579 Publication Model: eCollection Cited Medium: Internet ISSN: 2296-2565 (Electronic) Linking ISSN: 22962565 NLM ISO Abbreviation: Front Public Health Subsets: MEDLINE
Imprint Name(s): Original Publication: Lausanne : Frontiers Editorial Office
MeSH Terms: Coronary Disease*/therapy , Coronary Disease*/diagnosis , Coronary Disease*/mortality , Emergency Medical Services*/statistics & numerical data , Time-to-Treatment*/statistics & numerical data, Beijing/epidemiology ; Humans ; Female ; Prognosis ; Male ; Middle Aged ; Time Factors ; Aged ; Risk Factors ; Treatment Delay ; Registries
Abstract: 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.
(Copyright © 2026 Tan, Wang, Wang, Wang, Liu, Gao, Pan, Chen and Zhang.)
Competing Interests: The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Telemed J E Health. 2004;10 Suppl 2:S-110-6. (PMID: 23570221)
Eur Heart J. 2022 Oct 14;43(39):3971-3980. (PMID: 35194633)
Circulation. 2023 Jan 17;147(3):e32-e62. (PMID: 36503287)
J Am Coll Cardiol. 1996 Mar 15;27(4):774-8. (PMID: 8613602)
N Engl J Med. 1987 Jun 11;316(24):1514-8. (PMID: 3587281)
Chin J Nat Med. 2019 May 20;17(5):321-330. (PMID: 31171266)
Eur Heart J. 2021 May 14;42(19):1883-1895. (PMID: 33462618)
Eur J Prev Cardiol. 2025 Aug 25;32(11):1001-1015. (PMID: 39270739)
Clin Transl Immunology. 2021 Oct 31;10(11):e1352. (PMID: 34754449)
Int J Cardiol Cardiovasc Risk Prev. 2024 Mar 02;21:200253. (PMID: 38496330)
N Engl J Med. 1991 Oct 3;325(14):986-90. (PMID: 1886635)
Int J Mol Sci. 2022 Apr 01;23(7):. (PMID: 35409300)
N Engl J Med. 2013 Sep 5;369(10):901-9. (PMID: 24004117)
Arch Intern Med. 2010 Nov 8;170(20):1842-9. (PMID: 21059978)
Circulation. 2020 Oct 20;142(16_suppl_2):S366-S468. (PMID: 33081529)
Am J Med. 2024 Dec;137(12):1227-1235.e8. (PMID: 39233017)
Int J Clin Pract. 2012 Jan;66(1):69-76. (PMID: 22171906)
Nat Rev Immunol. 2011 Aug 05;11(9):625-32. (PMID: 21818124)
Am J Epidemiol. 2007 Mar 15;165(6):710-8. (PMID: 17182981)
Front Immunol. 2018 Sep 06;9:2031. (PMID: 30237802)
Biometrics. 1983 Jun;39(2):499-503. (PMID: 6354290)
J Geriatr Cardiol. 2024 Jan 28;21(1):81-89. (PMID: 38440336)
J Geriatr Cardiol. 2023 Jun 28;20(6):399-430. (PMID: 37416519)
JACC Cardiovasc Interv. 2011 Feb;4(2):183-90. (PMID: 21349457)
Telemed J E Health. 2009 Apr;15(3):241-7. (PMID: 19382861)
Coron Artery Dis. 2025 Jun 1;36(4):303-311. (PMID: 39692438)
Telemed J E Health. 2009 Nov;15(9):891-7. (PMID: 19919196)
Curr Probl Cardiol. 2021 Mar;46(3):100484. (PMID: 31610953)
J Hypertens. 1994 Aug;12(8):939-45. (PMID: 7814853)
J Clin Epidemiol. 1995 Dec;48(12):1503-10. (PMID: 8543964)
Int J Environ Res Public Health. 2023 Apr 25;20(9):. (PMID: 37174152)
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Int J Cardiol. 2016 Nov 1;222:242-246. (PMID: 27497102)
Lancet. 2015 Mar 21;385(9973):1114-22. (PMID: 25467573)
Contributed Indexing: Keywords: coronary heart disease; prehospital triggers; prognosis; symptom-to-door time; time of onset
Entry Date(s): Date Created: 20260825 Date Completed: 20260825 Latest Revision: 20260826
Update Code: 20260826
PubMed Central ID: PMC13500482
DOI: 10.3389/fpubh.2026.1834053
PMID: 42638695
Database: MEDLINE
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  Data: Impact of prehospital triggers, time of onset, and symptom-to-door time on the prognosis of patients with coronary heart disease.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Tan+X%22&quot;&gt;Tan X&lt;/searchLink&gt;; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Wang+X%22&quot;&gt;Wang X&lt;/searchLink&gt;; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Wang+M%22&quot;&gt;Wang M&lt;/searchLink&gt;; Department of Cardiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Wang+J%22&quot;&gt;Wang J&lt;/searchLink&gt;; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Liu+Y%22&quot;&gt;Liu Y&lt;/searchLink&gt;; Department of Cardiology, Guang&#39;anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Gao+M%22&quot;&gt;Gao M&lt;/searchLink&gt;; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Pan+Y%22&quot;&gt;Pan Y&lt;/searchLink&gt;; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Chen+M%22&quot;&gt;Chen M&lt;/searchLink&gt;; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Zhang+C%22&quot;&gt;Zhang C&lt;/searchLink&gt;; Infectious Diseases Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
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– Name: Abstract
  Label: Abstract
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  Data: 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.&lt;br /&gt;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.&lt;br /&gt;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 &amp;lt; 0.001; P for overall &amp;lt; 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 &amp;lt; 0.05).&lt;br /&gt;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.&lt;br /&gt; (Copyright &#169; 2026 Tan, Wang, Wang, Wang, Liu, Gao, Pan, Chen and Zhang.)
– Name: Abstract
  Label: Competing Interests
  Group: Ab
  Data: The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
– Name: Ref
  Label: References
  Group: RefInfo
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  Data: &lt;i&gt;Keywords: &lt;/i&gt;coronary heart disease; prehospital triggers; prognosis; symptom-to-door time; time of onset
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        Value: 10.3389/fpubh.2026.1834053
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        Text: English
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        StartPage: 1834053
    Subjects:
      – SubjectFull: Beijing epidemiology
        Type: general
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Female
        Type: general
      – SubjectFull: Prognosis
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      – SubjectFull: Male
        Type: general
      – SubjectFull: Middle Aged
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      – SubjectFull: Time Factors
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      – SubjectFull: Aged
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      – SubjectFull: Risk Factors
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      – SubjectFull: Treatment Delay
        Type: general
      – SubjectFull: Registries
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      – SubjectFull: Coronary Disease therapy
        Type: general
      – SubjectFull: Coronary Disease diagnosis
        Type: general
      – SubjectFull: Coronary Disease mortality
        Type: general
      – SubjectFull: Emergency Medical Services statistics & numerical data
        Type: general
      – SubjectFull: Time-to-Treatment statistics & numerical data
        Type: general
    Titles:
      – TitleFull: Impact of prehospital triggers, time of onset, and symptom-to-door time on the prognosis of patients with coronary heart disease.
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            – D: 10
              M: 08
              Text: 2026 Aug 10
              Type: published
              Y: 2026
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            – Type: issn-electronic
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          Titles:
            – TitleFull: Frontiers in public health
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