Key result
Meeting the ≤90-minute FMC-to-PCI goal in rural STEMI patients is linked to ~75% lower in-hospital mortality.
Why the study?
Guidelines recommend an EMS FMC to PCI time of <=90 min, but the association between FMC to PCI time and mortality in rural STEMI patients needed evaluation.
Does FMC to PCI time ≤90 min reduce index hospitalization mortality in rural STEMI patients?
Cohort (n=365)
Yes
Does FMC to PCI time ≤90 min reduce index hospitalization mortality in rural STEMI patients?
Absolute Event Rate: 1.4% vs 5.6%
p-value: p=0.03
In rural STEMI patients, achieving an FMC to PCI time of ≤90 minutes is associated with a significantly lower index hospitalization mortality compared to exceeding this time goal.
Supports timely PCI targets in rural STEMI; leaves open causal benefit without randomized confirmation.
BACKGROUND: ST-elevation myocardial infarction (STEMI) guidelines recommend an emergency medical services (EMS) first medical contact (FMC) to percutaneous coronary intervention (PCI) time of ≤90 min. The primary objective of this study was to evaluate the association between FMC to PCI time and mortality in rural STEMI patients. METHODS: We conducted a cohort study of patients ≥18 years old with STEMI activations from January 2016 to March 2020. Data were obtained from a rural North Carolina Regional STEMI Data Registry, which included eight rural EMS agencies and three PCI centers, the National Cardiovascular Data Registry, and the EMS electronic health record. Prehospital and in-hospital time intervals were digitally abstracted. The outcome of index hospitalization mortality was compared between patients who did and did not meet FMC to PCI time goal using Fisher's exact tests. Negative predictive value (NPV) for index hospitalization death was calculated with 95% confidence intervals (CIs). A receiver operating characteristic curve was constructed and an optimal FMC to PCI time goal was identified by maximizing NPV to prevent index hospitalization death. RESULTS: Among 365 rural EMS STEMI patients, 30.1% (110/365) were female with a mean ± SD age of 62.5 ± 12.7 years. PCI was performed within the 90-min time goal in 60.5% (221/365) of patients. Among these patients, 3% (11/365) died during initial STEMI hospitalization, with 1.4% (3/221) mortality in the group that met the 90-minute time goal compared to 5.6% (8/144) in patients exceeding the time goal (p = 0.03). Meeting the 90-min time goal yielded a 98.6% (95% CI 96.1%-99.7%) NPV for index death. A 78-min FMC to PCI time was the optimal cut point, yielding a NPV for index mortality of 99.3% (95% CI 96.1%-100%). CONCLUSIONS: Death among rural patients with STEMI was four times more likely when they did not receive PCI within 90 min.
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Stopyra et al. (2023) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=365). First medical contact to PCI time ≤90 min vs. First medical contact to PCI time >90 min was evaluated on Index hospitalization mortality (p=0.03). Meeting the ≤90-minute first medical contact to PCI time goal in rural STEMI patients was associated with lower index hospitalization mortality compared to exceeding the goal (1.4% vs 5.6%; p=0.03).
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