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Impact of patient delay in a modern real world STEMI network
Enrico Fabris1, Paola Arrigoni1, Luca Falco1
1Cardiovascular Department, University of Trieste, Trieste, Italy.
Insights
Patient delay in seeking care for ST-elevation myocardial infarction (STEMI) independently predicts lower left ventricular ejection fraction (LVEF) when system response times meet guidelines. Improving patient awareness is crucial for better STEMI outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Patient delay in seeking medical attention for ST-elevation myocardial infarction (STEMI) is a critical factor in treatment outcomes.
- The impact of patient delay on left ventricular ejection fraction (LVEF) is not well understood when system response times adhere to recommended guidelines.
Purpose of the Study:
- To investigate the independent predictors of pre-discharge decreased LVEF (≤45%) in STEMI patients.
- To determine if patient delay is a significant factor in reduced LVEF when system delay is optimized.
Main Methods:
- A cohort of 490 STEMI patients treated with primary percutaneous coronary intervention (pPCI) within 120 minutes of ECG diagnosis was analyzed.
- Multivariable analysis was used to identify independent predictors of pre-discharge LVEF ≤45%, including patient delay and clinical characteristics.
Main Results:
- Patient delay exceeding the median (58.5 minutes) was an independent predictor of pre-discharge LVEF ≤45% (OR 2.030).
- Anterior myocardial infarction and Killip class III-IV were also significant predictors of decreased LVEF.
- These findings were consistent even when considering shorter system delay times (≤90 minutes).
Conclusions:
- When system delay for pPCI is within recommended guidelines, patient delay emerges as a significant independent predictor of reduced LVEF.
- These results highlight the importance of addressing patient-side delays in STEMI management to improve cardiac function.
- Interventions aimed at reducing patient delay are crucial for optimizing STEMI patient outcomes.
Background:
The impact of patient delay on left ventricular ejection fraction (LVEF), when system delay has performance that meets the current recommended guidelines, is poorly investigated.
Methods:
We evaluated a cohort of STEMI patients treated with primary percutaneous coronary intervention (pPCI) and with an ECG STEMI diagnosis to wire crossing time (ETW) ≤120 min. Independent predictors of pre-discharge decreased LVEF (≤45%) were analyzed.
Results:
490 STEMI patients with both ETW time ≤120 min and available pre-discharge LVEF were evaluated. Mean age was 64.2 ± 12 years, 76.2% were male, 19.5% were diabetics, 42.7% had and anterior myocardial infarction (MI), and 9.8% were in Killip class III-IV. Median time of patient's response to initial symptoms (patient delay) was 58,5 (IQR 30;157) minutes and median ETW time was 78 (IQR 62-95) minutes. 115 patients (23.4%) had pre-discharge LVEF ≤45%. At multivariable analysis independent predictors of decreased LVEF (≤45%) were anterior MI (OR 4,659, 95% CI 2,618-8,289, p < 0,001), Killip class (OR 1,449, 95% CI 1,090-1,928, p = 0,011) and patients delay above the median (OR 2,030, 95% CI 1,151-3.578, p = 0,014). These independent predictors were confirmed in patients with ETW time ≤90 min.
Conclusions:
When system delay meets the recommended criteria for pPCI, patient delay becomes an independent predictor of pre-discharge LVEF. These findings provide further insights into the potential optimization of STEMI management and identify a target that needs to be improved, considering that still a significant proportion of patients continue to delay seeking medical care.
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