Increasing pre-hospital delay time in STEMI patients was associated with a 2% higher risk of 14-day mortality per hour of delay (HR 1.018).
Does increased prehospital delay time increase mortality in patients with ST-elevation myocardial infarction?
Pre-hospital delay time in STEMI is an independent predictor of short- and long-term mortality, with women, the elderly, and diabetic patients experiencing consistently longer delays.
Absolute Event Rate: 0% vs 0%
Abstract Background Longer ischaemic time during ST-elevation myocardial infarction (STEMI) is associated with higher mortality. However, how prehospital delay time affects outcomes and has evolved over time remains unknown. The aims were to study prognostic impact of prehospital delay time in STEMI patients during two decades in Sweden, and to explore temporal trends and differences stratified by age, sex and presence of diabetes mellitus. Methods Observational prospective cohort study based on the SWEDEHEART registry 1998-2017. Associations between prehospital delay time and 14-day, 1-year and 5-year mortality were estimated with Kaplan Meier and Cox regression analyses. Results Among 89155 patients higher short- and long-term mortality was observed with increasing prehospital delay time. The multivariable adjusted risk of 14-days mortality increased approximately 2% per hour of delay (hazard ratio HR 1.018, 95% confidence interval CI 1.011-1.025), whereas the corresponding number for 1- and 5 year-mortality was 1% (HR 1.011, 95% CI 1.006-1.016 and HR 1.009, 95% CI 1.005-1.013, respectively). No significant trend of prehospital delay time during the 20 years was observed (median 150 minutes, interquartile range IQR 80-302), as the curve was hump-shaped. During the fibrinolytic era (1998-2004) prehospital delay time significantly increased while it decreased during the primary percutaneous coronary intervention (PPCI) era (2005-2017). Consistently prolonged prehospital delay times were shown in women, elderly (70 years), and patients with diabetes with a delay 25-30 minutes longer than their counterparts. Conclusions Pre-hospital delay is an independent predictor of mortality. Whereas no declining trend was observed the last 20 years it is reassuring that a decrease of delay was found during the PPCI era. Women, elderly, and individuals with diabetes had consistently prolonged delay times and needs to be targeted in future interventions.
Ericsson et al. (Fri,) reported a other. Increasing pre-hospital delay time in STEMI patients was associated with a 2% higher risk of 14-day mortality per hour of delay (HR 1.018).