Analysis of 1452 STEMI patients undergoing primary PCI revealed a median first medical contact to diagnosis time of 80 minutes and total ischemia time of 311 minutes, indicating delays in care.
Observational (n=1,452)
No
The study identifies significant delays in the STEMI care pathway, particularly in first medical contact to diagnosis and transportation, highlighting the need for targeted quality improvement interventions.
Abstract Ischemic heart disease stands as the predominant cause of mortality. The mortality rate among individuals experiencing an acute coronary syndrome with ST-elevation (STEMI) is influenced by various factors, including the time lapse before treatment, encompassing primary percutaneous coronary angioplasty (PPCI) or fibrinolysis. To enhance the quality of care, it is essential to systematically document and assess treatment delays. We aim to analyse and characterized the times and delays in the emergent coronary referral pathway in our region. Methods and Results: Consecutive STEMI patients admitted for PCI in our centre, from 2015 to 2021, were included. We gathered data on following time variables: patient delay, electrocardiogram (ECG) delay, logistic delay, transport delay, home delay, procedure time. These variables enabled calculation of the following time frames: first medical contact (FMC) to diagnosis time, door-in-door out time (DIDO), door to wire, diagnosis to wire, FMC to wire and total ischemia time. Over 7 years, we included a total of 1452 cases, with a median age of 64± 14 years and 75.3%male. The analysis revealed a median patient delay of 90min (IQR 145), while the ECG delay mean was 20min (IQR 47). DIDO time was 112min (IQR 151), diagnostic delay was 40min (IQR 40) and FMC to diagnostic time was 80min (IQR 139). The median time of logistic delay was 28min (IQR 54), transport time was 58min (IQR 25) and home delay was 16min(IQR 57). In our population, procedure time was 28min (IQR 14), door to wire time was 52min (IQR 57), diagnosis to wire time was 87min (IQR 73), FMC to wire time was 194min (IQR 147) and the total ischemia time was 311min (IQR 303). Conclusion: Our work shows several points in which there should be a direct intervention in order to improve quality of care. Firstly, the global median time from FMC to diagnosis is still far from the expected target (80 minutes vs 10 minutes in European Society of Cardiology). The median time to perform an ECG is higher than the target. Improving this aspect could involve establishing a dedicated team to promptly conduct ECG assessments in alignment with the patient's symptoms. The diagnosis to wire is more forthcoming with a median of 87min. In order to reduce logistic and transportation delays, establishing a regional transport network for critical patients is crucial. This becomes particularly significant in our geographical area, where considerable distances separate centres lacking hemodynamic facilities and accessibility is suboptimal.
Viana et al. (Fri,) conducted a observational in ST-elevation myocardial infarction (STEMI) (n=1,452). Primary percutaneous coronary intervention (PPCI) pathway was evaluated on Times and delays in the emergent coronary referral pathway. Analysis of 1452 STEMI patients undergoing primary PCI revealed a median first medical contact to diagnosis time of 80 minutes and total ischemia time of 311 minutes, indicating delays in care.