In STEMI patients, a symptom-to-first medical contact delay >11 hours increased mechanical complication risk 5.51-fold and these complications raised in-hospital mortality risk 28.3-fold.
Does delayed presentation (>11 hours from symptom onset to first medical contact) increase the risk of mechanical complications and in-hospital mortality in patients with STEMI?
A delay of more than 11 hours from symptom onset to first medical contact is a strong independent predictor of mechanical complications in STEMI, which are associated with extremely high in-hospital mortality.
Abstract Background Mechanical complications are a significant cause of morbidity and mortality in patients hospitalized for myocardial infarction. Purpose To identify independent predictors of mechanical complications in patients with ST-elevation myocardial infarction (STEMI) and assess their impact on in-hospital mortality. Methods Consecutive patients with myocardial infarction were enrolled from 2017 to 2024. STEMI was defined according to European Guidelines. Patients who developed mechanical complications were stratified based on the time delay between symptom onset and first medical contact (FMC): earlycomers (12 hours) and latecomers (12 hours). Using receiver operating characteristic (ROC) curves, we determined the optimal cutoff time from symptom onset to FMC for predicting mechanical complications, based on the Youden index. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of mechanical complications. Additionally, univariate regression analysis was conducted to evaluate the association between each mechanical complication and in-hospital mortality. Results A total of 2207 patients were admitted for STEMI, of whom 53 (2.4%) experienced mechanical complications. Among these patients, 17 (30.3%) were earlycomers, while 39 (69.7%) were latecomers (p0.001). The most common mechanical complications were ventricular free wall rupture (41.1%) and ventricular septal rupture (44.6%). The ROC analysis showed that the time delay from symptom onset to FMC is highly capable of identify patients who developed mechanical complications with an area under the curve (AUC) of 0.796 (95% CI: 0.728-0.863) and an optimal cutoff value of 11 hours was identified. In multivariable analysis, the strongest predictor of mechanical complications was a delay of 11 hours from symptom onset (OR: 5.51, 95% CI: 2.72-11.15, p0.001), together with male sex (OR: 2.37, 95% CI: 1.26-4.44, p=0.007) and high Killip class (OR: 2.10, 95% CI: 1.64-2.7, p0.001). Conversely, percutaneous revascularization had a protective effect (OR: 0.44, 95% CI: 0.23-0.86, p=0.016). Among the 53 patients with mechanical complications, 34 died during hospitalization. Patients with mechanical complications had a significantly higher in-hospital mortality risk (OR: 28.3, 95% CI: 15.8-50.7, p0.001). The highest mortality was observed in those with ventricular free wall rupture, which was associated with an OR of 79.6 (95% CI: 26.7-237.4, p0.001). Conclusions in STEMI patients, mechanical complications are a major determinant of in-hospital mortality. In our study, a delayed presentation further confirms its role as a significant predictor of mechanical complications. Specifically, a delay of more than 11 hours from symptom onset to FMC was the strongest independent predictor of mechanical complications.ROC curve
Salerno et al. (2025) studied this question. In STEMI patients, a symptom-to-first medical contact delay >11 hours increased mechanical complication risk 5.51-fold and these complications raised in-hospital mortality risk 28.3-fold.
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