Key result
Prolonged symptom-to-door time over 6 hours linked to ~2.3-fold higher in-hospital STEMI complications.
Why the study?
The association between prolonged symptom-to-door time and adverse in-hospital outcomes in STEMI, and the share of this association statistically represented by cardiogenic-shock status, needed to be quantified.
Is prolonged symptom-to-door time (>6 hours) associated with higher odds of composite adverse in-hospital outcomes in adults presenting to the emergency department with STEMI, and what share of this association is statistically represented by cardiogenic-shock status?
Cross-Sectional (n=760)
No
Is prolonged symptom-to-door time (>6 hours) associated with higher odds of composite adverse in-hospital outcomes in adults presenting to the emergency department with STEMI, and what share of this association is statistically represented by cardiogenic-shock status?
In STEMI patients presenting to the emergency department, symptom-to-door delay exceeding 6 hours more than doubles the adjusted odds of major in-hospital adverse events, with cardiogenic shock statistically accounting for approximately one-third of this excess risk.
Answers are grounded in this paper and cite their sources.
May inform strategies to reduce STEMI presentation delays; cross-sectional data leaves causal impact open.
Objectives: To quantify the association between prolonged symptom-to-door (StD) time and adverse inhospital outcome status in ST-segment elevation myocardial infarction (STEMI), and what share of it is statistically represented by cardiogenic-shock status.Methods: Record-based retrospective cross-sectional study of 760 completed index hospital episodes among adults presenting directly to one emergency department with STEMI (March 2020 to August 2025), each contributing one record built at final in-hospital disposition.The exposure was prolonged StD time (>6 h), the pathway variable cardiogenic-shock status, and the outcome a composite of death, cardiac arrest, sustained ventricular arrhythmia, stroke or mechanical complication, from which shock was excluded.Sequentially adjusted logistic models, standardized decomposition with 500 bootstrap resamples, componentspecific decomposition, E-values and sensitivity analyses were applied.Results: Median StD time was 3.34 h (IQR 1.85-5.93);24.5% exceeded 6 h.Cardiogenic-shock status was present in 10.8% patients and the composite outcome in 15.7%.Prolonged StD time was associated with the outcome in the fully adjusted model (OR 2.28, 95% CI 1.48-3.53,P<0.001) and with cardiogenic-shock status (OR 4.57, 95% CI 2.77-7.53),retaining a residual association after shock was included (OR 1.79, 95% CI 1.13-2.83).Decomposition attributed 30.9% (95% CI 13.0-75.1%) of the log-scale association to shock, concentrated in death and cardiac arrest.The E-value was 3.34.Conclusions: Prolonged StD time was associated with higher odds of adverse in-hospital outcome status, and cardiogenic-shock status statistically represented about one third of this association.Because all variables were summarized at a single record-closure assessment, these are statistical associations, not causal mediation.
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Liang et al. (2026) conducted a cross-sectional in ST-segment elevation myocardial infarction (STEMI) (n=760). Prolonged symptom-to-door time (>6 hours) vs. Symptom-to-door time ≤6 hours was evaluated on Composite adverse in-hospital outcome status (in-hospital death, resuscitated cardiac arrest, sustained ventricular tachycardia or ventricular fibrillation requiring treatment, in-hospital stroke, or acute mechanical complication; excluding cardiogenic shock) (OR 2.28, 95% CI 1.48-3.53, p=<0.001). Prolonged symptom-to-door time (>6 h) was associated with higher odds of composite adverse in-hospital outcomes in STEMI patients.
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