Related Experiment Video
Updated: Jun 19, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Factors explaining the under-use of reperfusion therapy among ideal patients with ST-segment elevation myocardial
David A Alter1, Dennis T Ko, Alice Newman
1Institute for Clinical Evaluative Sciences, G106-2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5. david.alter@ices.on.ca
Insights
Delays in hospital arrival, higher bleeding risk, and more comorbidities significantly reduce reperfusion therapy for ST-segment elevation myocardial infarction (STEMI) patients. Addressing these factors is crucial for improving timely treatment and patient outcomes.
Area of Science:
- Cardiology
- Health Services Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring prompt reperfusion therapy.
- Identifying factors influencing reperfusion therapy utilization is essential for optimizing patient care.
Purpose of the Study:
- To assess the impact of time to hospital arrival, cardiovascular risk, intracerebral hemorrhage risk, and comorbidity burden on reperfusion therapy non-utilization in STEMI patients without contraindications.
Main Methods:
- Retrospective analysis of 3994 STEMI patients admitted to 103 hospitals in Ontario, Canada (1999-2001).
- Exclusion of patients with contraindications (n=909).
- Multivariable analysis to determine predictors of non-utilization of reperfusion therapy (fibrinolysis or primary PCI).
Main Results:
- 23.1% of eligible STEMI patients did not receive reperfusion therapy.
- Key predictors of non-utilization, in order of importance, were: increased time to hospital, higher intracerebral hemorrhage risk, higher baseline cardiovascular risk, and greater comorbidity burden.
- These factors independently and additively influenced treatment decisions, not solely explained by age or specific subgroups.
Conclusions:
- Care gaps in reperfusion therapy for STEMI patients are exacerbated by higher cardiovascular and intracerebral hemorrhage risks.
- Clinical decision tools may improve risk-benefit assessments and reduce treatment gaps for life-saving therapies.
Aims:
To determine the relative impact of time to hospital arrival, baseline cardiovascular risk (i.e.TIMI mortality risk index), intracerebral haemorrhage risk, and comorbid disease burden on the likelihood of not receiving reperfusion therapy among ST-segment elevation myocardial infarction (STEMI) patients without contraindications to treatment.
Methods And Results:
Retrospective population-based cohort of 3994 patients admitted to 103 acute care hospitals with chest pain and STEMI within 12 h of symptom onset in Ontario, Canada, between 1999 and 2001. Patients with one or more documented absolute or relative contraindication (n = 909) were excluded from the analyses. Reperfusion therapy was defined as the receipt of either fibrinolysis or primary percutaneous coronary intervention. Multivariable analysis and likelihood chi2 was used to quantify the importance of each factor in predicting the non-utilization of therapy. In total, 23.1% of patients received no reperfusion therapy. Listed in order from greatest to least importance, predictors of non-utilization of reperfusion therapy included increasing time to hospital presentation (likelihood chi2 31.6, P < 0.001), higher intracerebral haemorrhage risk (likelihood chi2 27.1, P < 0.001), higher baseline cardiovascular risk (likelihood chi2 25.4, P < 0.001), and greater number of chronic comorbid conditions (likelihood chi2 15.4, P < 0.001). The importance of each factor on non-utilization was independent, additive, not explained by age effects alone, or driven by subgroups traditionally under-represented in clinical trials.
Conclusion:
Care gaps in the use of reperfusion therapy widen with both increasing baseline cardiovascular risk and increasing intracerebral haemorrhage risk. Future studies should examine whether the implementation of clinical decision tools which allow for more accurate risk-benefit tradeoff predictions improve the treatment gaps when using life-saving therapies in this patient population.
More Related Videos
07:50Delayed Intramyocardial Delivery of Stem Cells after Ischemia Reperfusion Injury in a Murine Model
Published on: September 3, 2020
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care