Abstract: Background　Prehospital delay in seeking treatment in patients with acute myocardial infarction（AMI）is a vital factor on patients outcome.However，most studies focus on demographic factors，clinical symptoms and display of AMI，and cognitive aspects，and there is a lack of systematic research on social-psychological factors.As a common psychological factor，anxiety and its effects over AMI patient's prehospital time（PHT）has not yet been reported.Objective　Our study was to assess the impact of anxiety on PHT of AMI patients in order to provide a basis for the development of prehospital delay intervention strategies for anxiety-related AMI patients.Methods　In this multi-centered，cross-sectional observational study，we enrolled 265 patients diagnosed with AMI from four hospitals（Tongji Hospital of Tongji University，Tenth People's Hospital of Tongji University，Yangpu Hospital Tongji University，People's Liberation Army No.411 Hospital）in Shanghai from April 2016 to February 2017.Data collection included demographic status，symptoms of AMI onset，decision time，transit time，PHT（the time of symptom onset to the arrival at hospital door）．Anxiety was measured with the Generalized Anxiety Disorder-7（GAD-7）．Results　The mean PHT of 265 patients was 150.0（70.0，501.0）min.The results of anxiety assessment showed that a total of 104 patients displayed symptoms of anxiety（mild，n=81； moderate，n=16； severe，n=7）．We found that patients with anxiety were more likely to display sign of depression，cardiac denial and fear of death（P<0.05）．The incidence of feeling of death and dizziness in anxious patients was higher than non-anxious patients（P<0.05）．There was no significant difference in decision time，transit time and PHT between anxious and non-anxious patients（P>0.05）．PHT and decision time in patients with severe anxiety tended to be longer than those with mild anxiety（P<0.05）．There was no significant difference in the transit time of patients with different degrees of anxiety（P>0.05）．Conclusion　Patients with AMI and anxiety are more likely to have depression and cardiac denial.In comparison to patients who are mildly anxious，severely anxious patients with AMI might significantly prolong decision time and PHT，which is more likely to cause the miss of the optimal reperfusion period and affect the prognosis.

Key words: Myocardial infarction, Anxiety, Emergency treatment, Prehospital delay, Psychology-cardiology medicine

摘要： 背景　急性心肌梗死（AMI）患者院前延误时间（PHT）延长是影响救治效果的主要因素。现关于PHT的研究越来越多，但多集中在社会人口学因素、AMI临床症状、发病情景、认知等层面，而缺乏对社会心理因素的系统研究。焦虑是AMI患者常见心理问题，但在中国人群中其是否影响AMI患者PHT尚未见相关报道。目的　探究焦虑对AMI患者PHT的影响，以期为AMI伴焦虑患者院前延误干预策略的制订提供依据。方法　本研究为多中心横断面研究，连续选取2016年4月—2017年2月于上海市4家医院（同济大学附属同济医院、同济大学附属第十人民医院、上海市杨浦区中心医院和解放军第411医院）就诊的AMI住院患者265例为研究对象。收集患者一般资料、AMI发病时症状、决定时间、转运时间、PHT（患者发病至到达医院的时间），采用广泛性焦虑障碍量表（GAD-7）评估患者焦虑情况。结果　265例患者的PHT为150.0（70.0，501.0）min；焦虑评估结果：无焦虑161例，有焦虑104例（其中轻度焦虑81例，中度焦虑16例，重度焦虑7例）。有焦虑患者抑郁、心脏否认发生率及怕死程度得分高于无焦虑患者（P<0.05）。有焦虑患者濒死感、头晕发生率高于无焦虑患者（P<0.05）。无焦虑与有焦虑患者决定时间、转运时间、PHT比较，差异无统计学意义（P>0.05）。重度焦虑患者决定时间、PHT长于轻度焦虑患者（P<0.05）；不同焦虑程度患者转运时间比较，差异无统计学意义（P>0.05）。结论　AMI伴焦虑患者更易发生抑郁、心脏否认，重度焦虑患者较轻度焦虑患者决定时间、PHT更长，从而更可能错过最佳再灌注治疗时间，影响预后。

关键词: 心肌梗死, 焦虑, 急诊处理, 院前延误, 双心医学