Management Delays in NSTE-ACS at a Moroccan Tertiary Care Center: Patterns and Factors Associated with Late Presentation

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) (n=120). Intervention: Abnormal ECG findings (along with distance from center, admission troponin, and baseline LVEF) vs. Early presentation (symptom-to-door delay ≤24 hours). Primary outcome: Late presentation (prolonged prehospital symptom-to-door delay >24 hours) (OR 3.957, 95% CI 1.203-13.013, p=0.024).

Q: What does this research mean for the field?

Prolonged prehospital delay (>24 hours) affects nearly half of NSTE-ACS patients and is independently associated with greater distance to the care center, an abnormal ECG, lower admission troponin, and lower baseline left ventricular ejection fraction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Asmaa Hassani; Oumayma El Khabote; Tanae El Ghali; Latifa Oukerraj; Mohammed Cherti

doi:10.36347/sasjm.2026.v12i10.007

October 7, 2026SAS Journal of MedicineOpen Access

Management Delays in NSTE-ACS at a Moroccan Tertiary Care Center: Patterns and Factors Associated with Late Presentation

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Key result

Abnormal ECG linked to ~4-fold higher odds of prolonged prehospital delay in NSTE-ACS.

OR 3.957
95% CI 1.203-13.013
P=0.024
n=120

Why the study?

NSTE-ACS requires timely diagnosis and treatment, yet Moroccan data on delayed hospital presentation remain limited.

What patient- and system-related factors are independently associated with prolonged prehospital delay (>24 hours) and subsequent left ventricular functional recovery in adults presenting with NSTE-ACS in Morocco?

Key Points

To investigate the extent of prehospital delays and identify clinical and geographic factors associated with late hospital presentation in patients with non-ST-segment elevation acute coronary syndrome.
Retrospective, observational, single-center study of 120 consecutive adult patients with NSTE-ACS undergoing coronary angiography at Ibn Sina University Hospital in Rabat between January 2024 and May 2026.
Prolonged prehospital delay was defined as a symptom-to-door time exceeding 24 hours, and independent predictors were determined using multivariable logistic regression.
Left ventricular functional recovery was evaluated by comparing LVEF changes between baseline and three-month follow-up.
Median symptom-to-door time was 24 hours [IQR, 12-72], with 54 patients (45.0%) presenting after >24 hours; median door-to-angiography and symptom-to-angiography times were 24 hours [IQR, 24-72] and 73 hours [IQR, 48-144], respectively.
Prolonged prehospital delay was independently associated with greater distance from the center (OR, 1.009; 95% CI, 1.001-1.017), abnormal ECG (OR, 3.957; 95% CI, 1.203-13.013), lower admission troponin (OR, 0.934; 95% CI, 0.873-0.998), and lower baseline LVEF (OR, 0.959; 95% CI, 0.924-0.994).
Among 31 patients evaluated at three months, median LVEF increased from 55% to 58% (p=0.003), but functional recovery showed no significant association with prehospital delay.

Study Design

Type

Observational (n=120)

Multicenter

No

Structured PICO

What patient- and system-related factors are independently associated with prolonged prehospital delay (>24 hours) and subsequent left ventricular functional recovery in adults presenting with NSTE-ACS in Morocco?

P

Population

120 consecutive adult patients (mean age 63.1 years, 37.5% female) with NSTE-ACS undergoing coronary angiography at a Moroccan tertiary care center, with a subset of 31 patients followed for 3 months.

E

Exposure

Late hospital presentation (symptom-to-door delay >24 hours, n=54) followed by coronary angiography and revascularization (75.0% PCI, 8.3% CABG, 16.7% optimal medical therapy overall)

C

Comparator

Early hospital presentation (symptom-to-door delay <=24 hours, n=66)

O

Outcome

Late presentation, defined as a symptom-to-door delay (STD) >24 hours, and independent factors associated with prolonged symptom-to-door delay identified via multivariable logistic regressionsurrogate

Main Result

Odds Ratio: 3.957 (95% CI 1.203–13.013)

Absolute Event Rate: 88.9% vs 77.3%

p-value: p=0.024

In a Moroccan tertiary care center, nearly half of NSTE-ACS patients experienced prehospital delays exceeding 24 hours—driven by greater distance to care, symptom neglect, and interhospital transfers—highlighting critical gaps between ESC guideline timelines and real-world practice.

Limitations

Retrospective, single-center design introducing potential selection and information bias and limiting generalizability
Relatively small overall sample size (n=120)
Data-driven 24-hour cutoff for delayed presentation rather than an externally validated clinical threshold
Three-month follow-up echocardiographic assessment was available for only 31 patients, limiting statistical power for secondary analyses
Infrequent major adverse cardiovascular events precluded evaluating the relationship between management delays and short-term clinical outcomes
Admission troponin levels may have been confounded by the timing of blood sampling relative to symptom onset
Lack of data on socioeconomic status and educational level

Implication

May inform targeted education for remote or ECG-abnormal patients; leaves open prospective validation in NSTE-ACS.

Abstract

Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) requires timely diagnosis and treatment, yet Moroccan data on delayed hospital presentation remain limited. This retrospective, observational, single-center study included 120 consecutive adults with NSTE-ACS who underwent coronary angiography at Ibn Sina University Hospital in Rabat between January 2024 and May 2026. Prolonged prehospital delay was defined as a symptom-to-door time of more than 24 hours, and associated factors were identified using multivariable logistic regression. Left ventricular functional recovery was assessed by the change in left ventricular ejection fraction (LVEF) from baseline to three months. Median symptom-to-door time was 24 hours [IQR, 12-72], and 54 patients (45.0%) presented more than 24 hours after symptom onset. Median door-to-angiography time was 24 hours [IQR, 24-72], and median symptom-to-angiography time was 73 hours [IQR, 48-144]. Greater distance from the tertiary care center (OR, 1.009; 95% CI, 1.001-1.017), an abnormal ECG (OR, 3.957; 95% CI, 1.203-13.013), lower admission troponin levels (OR, 0.934; 95% CI, 0.873-0.998), and lower baseline LVEF (OR, 0.959; 95% CI, 0.924-0.994) were independently associated with prolonged prehospital delay. Among 31 patients assessed at three months, median LVEF increased from 55% to 58% (p=0.003), but recovery was not significantly associated with prehospital delay. Prolonged prehospital delay was common and was related to both patient- and healthcare system-related factors. Improving symptom recognition, access to medical care, and regional referral pathways may help reduce delayed presentation.

Discussion

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Cite This Study

Hassani et al. (2026) conducted an observational in Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) (n=120). Abnormal ECG findings (along with distance from center, admission troponin, and baseline LVEF) vs. Early presentation (symptom-to-door delay ≤24 hours) was evaluated on Late presentation (prolonged prehospital symptom-to-door delay >24 hours) (OR 3.957, 95% CI 1.203-13.013, p=0.024). Prolonged prehospital delay (>24 h) occurred in 45.0% of NSTE-ACS patients, independently predicted by abnormal ECG (OR 3.957), greater distance (OR 1.009), lower troponin, and lower LVEF.

synapsesocial.com/papers/6ae28e56cbadf70daf6c41df https://doi.org/10.36347/sasjm.2026.v12i10.007

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Management Delays in NSTE-ACS at a Moroccan Tertiary Care Center: Patterns and Factors Associated with Late Presentation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Management Delays in NSTE-ACS at a Moroccan Tertiary Care Center: Patterns and Factors Associated with Late Presentation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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