Impact of admission time, mode of arrival, and hospital level on treatment delay among patients with ST elevation myocardial infarction

Abstract Introduction Primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST elevation myocardial infarction (STEMI). Treatment delay significantly affects the prognosis of STEMI patients. Currently, there are insufficient large-scale multicenter studies investigating the impact of admission time, mode of arrival, and hospital level on treatment delay among STEMI patients. Purpose This study aimed to investigate the treatment delay and its influencing factors for STEMI patients. Methods This was a retrospective observational study of STEMI patients who underwent PPCI from 65 hospitals between 1 January 2018 and 31 March 2022. The total ischemic time (TIT), pre-hospital delay symptom onset to door time (S2D) and in-hospital delay door to balloon time (D2B) were collected. Results This study included 13,445 STEMI patients, of whom 10,901 (81.1%) were male, with an average age of 59.6 ± 12.6 years. The median TIT was 188 minutes, S2D was 116 minutes, and D2B was 72 minutes. The proportion of patients with D2B 90 min, TIT 120 min, and TIT 720 min was 23.4%, 81.5%, and 1.3%, respectively. Median TIT did not differ according to on- versus off-hours admission (189 min vs. 187 min; P = 0.455). S2D was longer (120 min vs. 111 min; P 0.001), while D2B was shorter during on-hours (67 min vs. 74 min; P 0.001). The proportions of patients with D2B 90 min (20.3% vs. 25.2%; P 0.001) and TIT 120 min (79.8% vs. 82.5%; P 0.001) were lower in patients arriving during on-hours. Median TIT (193 min vs. 176 min; P 0.001), S2D (119 min vs. 102 min; P 0.001), and D2B (74 min vs. 68 min; P 0.001) were significantly longer for self-transported patients than for ambulance-transported patients. The proportions of self-transported patients with D2B 90 minutes (24.7% vs. 19.6%, P0.001) and TIT 720 minutes (1.5% vs. 0.8%, P=0.001) were higher compared to ambulance-transported patients. Median TIT (183 min vs. 195 min; P 0.001) and S2D (109 min vs. 120 min; P 0.001) were shorter for patients at non-tertiary first-class hospitals than for those at tertiary first-class hospitals, while D2B was longer (73 min vs. 69 min; P 0.001). The proportion of patients with D2B 90 minutes was higher at non-tertiary first-class hospitals (24.0% vs. 12.5%, P=0.042), while the proportion with TIT 120 minutes was lower (80.6% vs. 82.8%, P=0.001). Conclusions Admission time, mode of arrival, and hospital level all influence treatment delay in STEMI patients.Baseline characteristics Treatment delay