Time From Distress Call to Percutaneous Coronary Intervention and Outcomes in Myocardial Infarction
Elisabeth Helen Anna Mills1, Amalie Lykkemark Møller2, Thomas Engstrøm3
1Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Insights
Minimizing delays in percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is crucial. Longer wait times increase risks of death, recurrent heart attack, and heart failure.
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.
Background:
Early percutaneous coronary intervention (PCI) is recommended for ST-segment elevation myocardial infarction (STEMI) treatment. Delays in time-to-PCI, kept within guideline recommendations, have seldom been investigated.
Objectives:
The purpose of this study was to investigate the consequences of delay, due to system factors or hospital distance, for the time between last patient distress call and PCI.
Methods:
Registry-based cohort study including times of first call to medical services, admission and PCI for patients admitted with STEMI in Copenhagen, Denmark (2014-2018). The main combined outcome included death, recurrent myocardial infarction, or heart failure estimated at 30 days and 1 year from event. Outcomes according to time from call to PCI (system delay) and door-to-balloon time were standardized to the STEMI population using multivariate logistic regression.
Results:
In total, 1,822 STEMI patients (73.5% male, median age 63.3 years [Q1-Q3: 54.6-72.9 years]) called the emergency services ≤72 hours before PCI (1,735, ≤12 hours). The combined endpoint of 1-year cumulative incidence was 13.9% (166/1,196) for patients treated within 120 minutes of the call and 21.2% (89/420) for patients treated later. Standardized 30-day outcomes were 7.33% (95% CI: 5.41%-9.63%) for patients treated <60 minutes, and 11.1% (95% CI: 8.39%-14.2%) for patients treated >120 minutes.
Conclusions:
The risk of recurrent myocardial infarction, death, and heart failure following PCI treatment of STEMI increases rapidly when delay exceeds 1 hour. This indicates a particular advantage of minimizing time from first contact to PCI.
