Key result
Each hour increase in system delay before primary PCI for STEMI was associated with a higher risk of readmission or outpatient contact for heart failure (HR 1.10; 95% CI 1.02-1.17).
Why the study?
Does longer health care system delay increase the risk of readmissions or outpatient contacts due to congestive heart failure in patients with STEMI treated with primary percutaneous coronary intervention?
Cohort (n=7,952)
Does longer health care system delay increase the risk of readmissions or outpatient contacts due to congestive heart failure in patients with STEMI treated with primary percutaneous coronary intervention?
Longer health care system delays before primary PCI in STEMI patients are independently associated with an increased long-term risk of subsequent heart failure readmissions or outpatient contacts.
Answers are grounded in this paper and cite their sources.
May support minimizing STEMI system delays; leaves open whether shortening them reduces HF events.
BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI), delay between contact with the health care system and initiation of reperfusion therapy (system delay) is associated with mortality, but data on the associated risk for congestive heart failure (CHF) among survivors are limited. OBJECTIVE: To evaluate the association between system delay and the risk for readmissions or outpatient contacts due to CHF after primary percutaneous coronary intervention (PPCI) in patients with STEMI. DESIGN: Historical follow-up study using population-based medical registries. SETTING: Western Denmark. PATIENTS: Patients with STEMI who were transported by emergency medical service from 1 January 1999 to 7 February 2010 and treated with PPCI within 12 hours of symptom onset and who had a system delay of 6 hours or less (n = 7952). The median duration of follow-up was 3.1 years. MEASUREMENTS: Cumulative incidence of readmissions or outpatient contacts due to CHF was determined by using competing-risk regression analysis, with death as the competing risk. Crude and adjusted cause-specific hazard ratios for readmissions or outpatient contacts due to CHF were determined for system delay and other covariates. RESULTS: System delays of 60 minutes or less (n = 451), 61 to 120 minutes (n = 3457), 121 to 180 minutes (n = 2655), and 181 to 360 minutes (n = 1389) corresponded with long-term risks for readmissions or outpatient contacts due to CHF of 10.1%, 10.6%, 12.3%, and 14.1%, respectively (P < 0.001). In multivariable analysis, system delay was an independent predictor of readmissions or outpatient contacts due to CHF (adjusted hazard ratio per hour increase in delay, 1.10 [95% CI, 1.02 to 1.17]). LIMITATION: In any nonrandomized study, there are risks for selection bias and residual confounding. CONCLUSION: In patients with STEMI, shorter delay to PPCI is associated with lower risk for readmissions or outpatient contacts due to CHF during follow-up.
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Terkelsen et al. (2011) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=7,952). System delay vs. Shorter system delay was evaluated on Readmissions or outpatient contacts due to congestive heart failure (HR 1.10, 95% CI 1.02 to 1.17, p=<0.001). Each hour increase in system delay before primary PCI for STEMI was associated with a higher risk of readmission or outpatient contact for heart failure (HR 1.10; 95% CI 1.02-1.17).
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