Over 10 years, median call-to-balloon time for UK STEMI patients increased by 22 minutes, and the proportion of patients reperfused within 12 hours fell from 76.3% to 68.6%.
Observational (n=300,939)
Yes
How have system delays in STEMI reperfusion changed over a 10-year period in the UK?
Pre-hospital delays in STEMI care have significantly increased in the UK over the past decade, reducing the proportion of patients receiving timely reperfusion despite stable in-hospital door-to-balloon times.
Effect estimate: β -0.038 per min (95% CI -0.432 to 0.356)
p-value: p=0.827
Abstract Background Rapid reperfusion by primary percutaneous coronary intervention (PPCI) is vital for high-risk ST-elevation myocardial infarction (STEMI) cases. The 2023 ESC guidelines recommend system delays of less than 60 minutes from first medical contact to wire-crossing in PCI-capable centres or less than 90 minutes when transfer is required 1. Similarly, UK standards aim for call-to-balloon (CTB) times of ≤150 minutes and door-to-balloon (DTB) ≤60 minutes. However, emerging UK longitudinal audit data indicate that increasing CTB delays remain despite sustained in-hospital DTB performance, suggesting system bottleneck. Purpose We aimed to quantify temporal trends in UK STEMI performance (2014-2024) to evaluate the associations between system delays and timely reperfusion, supported by a contextual literature review of organisational contributors. Methods A longitudinal analysis of ten annual UK Myocardial Disease National Audit Project (MINAP) audit cycles was performed, encompassing 300,939 STEMI patients. We restricted inclusion to high-risk STEMI patients, as defined by the dataset. Performance metrics included median CTB, DTB times and proportions meeting CTB150/ 120 minutes and DTB 90 minutes, with a surrogate outcome of the proportion of patients re-perfused within 12 hours. Trends were evaluated using linear regression in R v4.5.1, with associations assessed by Spearman correlation adjusted for calendar year. A supporting literature search identified key determinants and emerging solutions. Results Over the study period, median CTB time increased by 22 minutes, while DTB remained stable (41-44 minutes). Reperfusion 12 hours fell from 76.3% to 68.6%. Each 10-minute CTB increase corresponded to a 0.38-percentage-point lower perfusion probability 12 h (β per min = -0.038, 95% CI -0.432 to 0.356, p = 0.827; model R² = 0.86), adjusted for calendar year. Spearman correlation between CTB and reperfusion 12 h was ρ = -0.93. Target attainment declined over time (CTB 150 min: 69.7% - 54.7%; CTB 120 min: 50% - 34%), whereas DTB 90 min was comparatively unchanged (76.7% - 71%). Conclusion Over the past decade, national audit data demonstrate that while improvements have been sustained within hospital catheter lab processes, delays in pre-hospital care have emerged as the primary barrier to timely reperfusion for STEMI patients in the UK. Considering that every 30-minute delay increases patient mortality by up to 7% 2, prompt change is warranted to optimise the upstream heart-team infrastructure. Addressing these gaps requires innovative solutions, including integrated real-time digital tracking from emergency call to reperfusion, unified regional and national governance and continuous open access data feedback. By leveraging open access data and international best practices 3, health systems can identify persistent issues and scale evidence-based interventions to save lives and optimise resource use.Relative Changes in Performance Metrics System Efficiency Index
Kundur et al. (2026) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=300,939). System delays (call-to-balloon time) was evaluated on Proportion of patients re-perfused within 12 hours (β -0.038 per min, 95% CI -0.432 to 0.356, p=0.827). Over 10 years, median call-to-balloon time for UK STEMI patients increased by 22 minutes, and the proportion of patients reperfused within 12 hours fell from 76.3% to 68.6%.