Key result
Patient delay, non-PCI hospital delay, and transfer delays were the main barriers significantly prolonging total ischemic time in STEMI patients undergoing primary PCI (p<0.001).
Cross-Sectional (n=191)
No
Patient delay, time spent at non-PCI facilities, and transfer delays are the primary barriers to achieving timely primary PCI for STEMI patients, highlighting the need for patient education and improved transfer protocols.
Delays limit timely total ischemic time in STEMI; observational data leaves open whether patient education and transfer improvements reduce ischemic burden.
Background and objectives: An estimated increase in risk of death exists for patients with ST-elevation myocardial infarction. Primary percutaneous coronary intervention may lower this risk if only performed on time. The aim of this study is to evaluate the barriers to achieving timely primary percutaneous coronary intervention. Methods: This is an observational/cross-sectional study conducted in Sulaimani city, Kurdistan Region of Iraq, from February 1, 2024, to January 31, 2025, on 200 patients with ST elevation myocardial infarction, assessment of time intervals from symptom onset to balloon, and the factors contributing to delay of primary percutaneous coronary intervention included in the questionnaire. Results: Most of the patients (80.1%) were male; the mean age was 60.69 ± 12.16 years. 132 patients, 69.1%, had a timely door to balloon time (≤ 60 minutes). The median door-to-balloon time was 50 minutes (IQR 25-75: 10-10200 minutes). Median total ischemic time was 380 minutes (IQR 25-75: 60-2950 minutes). 19 (10%) had timely total ischemic time (≤ 120 minutes). statistically significant correlation with gender, door in to door out time, symptom to door time, and door to balloon time (P = 0.016, <0.001). Barriers that significantly prolong total ischemic time were patient delay, non-percutaneous coronary intervention-capable center delay, delay during transfer to the PCI center (P <0.001), and delay team activation. Conclusion: Timely reperfusion is the mainstay of acute STEMI management. This study discovered that the main barriers of timely primary percutaneous coronary intervention are a patient’s delay to present to the hospital, longer duration of remaining in non-PCI facility hospital, and delaying during transferring to PCI-capable center. Focusing on patients’ education and alertness programs for acute chest pain are essential for enhancing total ischemic time.
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Taha et al. (2026) conducted a cross-sectional in ST-elevation myocardial infarction (n=191). Primary percutaneous coronary intervention was evaluated on Total ischemic time (TIT) (p=<0.001). Patient delay, non-PCI hospital delay, and transfer delays were the main barriers significantly prolonging total ischemic time in STEMI patients undergoing primary PCI (p<0.001).
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