Why the study?
Timely restoration of blood flow is critical for STEMI management, but the effects of delays at each care stage on mortality are not fully understood.
Do delays at each stage of care increase in-hospital mortality in patients with STEMI undergoing primary percutaneous coronary intervention?
Observational (n=315)
No
Do delays at each stage of care increase in-hospital mortality in patients with STEMI undergoing primary percutaneous coronary intervention?
Total ischemic time is the most critical time-based predictor of in-hospital mortality in STEMI patients undergoing primary PCI, emphasizing the need to minimize all components of delay.
Longer total ischemic time was associated with higher STEMI mortality; leaves open whether targeting delays improves outcomes in prospective studies.
BACKGROUND: Timely restoration of blood flow is critical for ST-segment elevation myocardial infarction (STEMI) management. We evaluate the effects of time intervals - total ischemic time, time from symptom onset to first medical contact, delay within the healthcare system, and time from hospital arrival to balloon inflation and from arrival at the catheterization laboratory to balloon inflation - on in-hospital mortality among patients with STEMI undergoing primary percutaneous coronary intervention. METHODS: We analyzed data from 315 patients with STEMI who underwent primary percutaneous coronary intervention in a hospital between 2020 and 2021. A random forest model was used to assess the predictive importance of time delay components for in-hospital mortality. RESULTS: Of the total sample, 35 patients died. The median (interquartile range) for total ischemic time was 310.0 (215.0-547.5) min. Univariate analysis showed significant differences between the two groups in time to first medical contact [120.0 (60.0-245.0) vs. 210.0 (120.0-272.5); P = 0.007] and total ischemic time [300.0 (210.0-531.2) vs. 370.0 (320.0-720.0); P = 0.001]; however, the multivariable model (accuracy = 0.971, sensitivity = 0.800, specificity = 0.999, and an area under the curve = 0.93) identified total ischemic time as the most important time-based predictor of mortality, followed by system delay, time from hospital arrival to balloon inflation, from symptom onset to first medical contact, and from arrival at the catheterization laboratory to balloon inflation. CONCLUSION: Each delay component in STEMI management carries distinct clinical consequences that necessitate targeted intervention.
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Rafizadeh et al. (2025) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=315). Time delays in care (total ischemic time, system delay, etc.) was evaluated on In-hospital mortality.
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