Time From Distress Call to Percutaneous Coronary Intervention and Outcomes in Myocardial Infarction

Area of Science:

• Cardiology
• Emergency Medicine
• Public Health

Background:

• Early percutaneous coronary intervention (PCI) is the recommended treatment for ST-segment elevation myocardial infarction (STEMI).
• The impact of delays in PCI, even within guideline recommendations, requires further investigation.
• System factors and hospital proximity significantly influence treatment timelines.

Purpose of the Study:

• To evaluate the consequences of delays on the time from initial patient distress call to PCI.
• To analyze delays attributed to systemic issues and hospital distance.
• To quantify the impact of these delays on patient outcomes.

Main Methods:

• A registry-based cohort study was conducted in Copenhagen, Denmark (2014-2018) involving STEMI patients.
• Data collected included times of first medical service call, hospital admission, and PCI.
• The primary combined endpoint assessed 30-day and 1-year cumulative incidence of death, recurrent myocardial infarction, or heart failure.
• Multivariate logistic regression standardized outcomes based on time from call to PCI (system delay) and door-to-balloon time.

Main Results:

• The study included 1,822 STEMI patients; 1,735 called emergency services within 72 hours of PCI.
• One-year cumulative incidence was 13.9% for patients treated within 120 minutes of the call versus 21.2% for those treated later.
• Standardized 30-day outcomes showed a 7.33% event rate for treatment within 60 minutes compared to 11.1% for treatment after 120 minutes.

Conclusions:

• The risk of adverse outcomes (death, recurrent MI, heart failure) following STEMI treatment increases significantly with delays exceeding one hour.
• Minimizing the time from the initial patient contact to PCI offers a distinct clinical advantage.
• Addressing system-related delays is critical for improving STEMI patient prognoses.