Delay in presentation and reperfusion therapy in ST-elevation myocardial infarction

Area of Science:

• Cardiology
• Emergency Medicine
• Health Services Research

Background:

• Timely reperfusion therapy is critical for ST-elevation myocardial infarction (STEMI) outcomes.
• Delays from symptom onset to hospital presentation are a key factor influencing treatment delivery.

Purpose of the Study:

• To investigate the association between delayed hospital presentation and the utilization of reperfusion therapy in STEMI patients.
• To analyze the impact of presentation delay on door-to-balloon and door-to-drug times.

Main Methods:

• A cohort study utilizing data from the National Registry of Myocardial Infarction (1995-2004).
• Patients were categorized by intervals of delay from symptom onset to hospital arrival (<1 hour to >12 hours).
• Analysis included 440,398 patients for reperfusion therapy, 67,207 for door-to-balloon time, and 183,441 for door-to-drug time.

Main Results:

• Increased delay from symptom onset to presentation was significantly associated with a lower likelihood of receiving any reperfusion therapy (P <.0001).
• Longer presentation delays correlated with extended door-to-balloon times and door-to-drug times.
• Specific examples show reperfusion rates dropping from 77% (<=1 hour) to 46% (>11-12 hours), with door-to-balloon times increasing from 99 to 123 minutes.

Conclusions:

• Significant delays in hospital presentation for STEMI negatively impact the chances of receiving primary reperfusion therapy.
• Even when treated, patients presenting later experience substantially longer door-to-balloon and door-to-drug times.
• These findings underscore the importance of reducing pre-hospital delays to optimize STEMI treatment and outcomes.