Impact of 24/7 STEMI Care: Evaluating the Timely Intervention in Puerto Rico

Cardiovascular disease remains the leading cause of adult mortality worldwide, with ST-elevation myocardial infarction (STEMI) representing its most severe acute presentation. Timely intervention, particularly through percutaneous coronary intervention (PCI), significantly improves outcomes. This study evaluated the performance of a regional STEMI protocol at San Lucas Episcopal Medical Center, the sole 24/7 PCI-capable facility in a large, underserved region of Puerto Rico. A retrospective descriptive study was conducted on patients with STEMI code activation between 2020 and 2025. Only confirmed cases with complete documentation were included. Data from the hospital’s Meditech system were extracted and entered into REDCap for analysis. A total of 218 patients were included, most male (78%), with a median age of 67 years. Hypertension, diabetes mellitus, coronary artery disease, and smoking history were the most common comorbidities. The left anterior descending artery was the most frequently identified culprit vessel. Stent placement was performed in 88.1% of cases. Femoral access was used in 62.8% of procedures and radial access in 35.8%. Most patients (94.5%) achieved door-to-balloon (D2B) times under 90 minutes, with a mean of 65 minutes. The median hospital stay was 4 days. Complications included arrhythmias (17%), respiratory failure (15.1%), cardiogenic shock (12.8%), vascular events (9.6%), and mechanical issues (2.8%). In-hospital mortality was 12.8%. In this cohort, STEMI occurred primarily among older men with modifiable cardiovascular risk factors. Despite high protocol adherence and procedural efficiency, notable complications and elevated mortality persisted. These findings suggest the need to explore additional factors influencing outcomes beyond reperfusion time alone.