Key result
Transfer from non-PCI centers significantly prolonged median total ischemic time to 250 minutes compared to 151 minutes in patients with ST-segment elevation myocardial infarction.
Why the study?
The study aimed to identify factors associated with delays from symptom onset to treatment in patients with acute myocardial infarction in Turkey to focus improvement efforts.
Observational (n=1,879)
Yes
A significant proportion of AMI patients in Turkey experience treatment delays exceeding guideline recommendations, largely driven by patient-related factors and low EMS utilization.
Answers are grounded in this paper and cite their sources.
Delays exceed guidelines in Turkish STEMI patients; hypothesis-generating for interventions targeting EMS use and interhospital transfers.
OBJECTIVE: In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey. METHODS: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT). RESULTS: After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15-180) min and from EMS call to EMS arrival 15 (10-20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25-63) min, and median TIT was 195 (115-330) min. TIT was significantly prolonged from 151 (90-285) min to 250 (165-372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI. CONCLUSION: The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment.
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Erol et al. (2021) conducted an observational in acute myocardial infarction (n=1,879). Transfer from non-PCI centers vs. Direct presentation to PCI centers was evaluated on Time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time and total ischemic time. Transfer from non-PCI centers significantly prolonged median total ischemic time to 250 minutes compared to 151 minutes in patients with ST-segment elevation myocardial infarction.
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