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Waiting longer from symptom onset to arrival at the emergency department for people with an acute myocardial infarction is associated with higher morbidity and mortality. Comment: This research found that the factors associated with a longer symptom-to-ER time included: a) older age, b) diabetes mellitus, and c) presenting symptoms of back and epigastric pain. This study was done in Singapore, and an additional associated factor related to a prolonged symptom-to-ER time was Malay ethnicity. Emerg Med Australas. 2016 Oct 11    (retrieved Oct, 2016). There are currently 1090 pearls in the database. While every attempt has been made to ensure accuracy, mistakes can and do occur. Use databank at your own risk. All pearls © 2024 by the Internet Medical Association. Click Here to view more medical pearls.