Clinical Characteristics and Outcomes Stratified by Time to ST-Segment Elevation Myocardial Infarction Presentation

Area of Science:

• Cardiology
• Acute Coronary Syndromes
• Public Health

Background:

• Limited data exists on clinical characteristics of ST-segment elevation myocardial infarction (STEMI) patients experiencing delayed hospital presentation.
• Understanding factors associated with delayed STEMI care is crucial for improving patient outcomes.

Purpose of the Study:

• To compare baseline characteristics and clinical outcomes of early versus late presenters with STEMI undergoing percutaneous coronary intervention (PCI).
• To identify factors independently associated with late presentation in STEMI patients.

Main Methods:

• Analysis of 719 consecutive STEMI patients who underwent PCI, categorized by symptom onset to door time (<2.3 hours for early, ≥2.3 hours for late).
• Comparison of demographic, clinical data, and procedural outcomes between early and late presentation groups.
• Multivariable analysis to determine independent predictors of late STEMI presentation.

Main Results:

• Late presenters (≥2.3 hours) were independently associated with late night to early morning symptom onset (OR, 2.03), age ≥75 years (OR, 1.56), and female sex (OR, 1.49).
• Culprit lesions in the right coronary artery (RCA) were inversely associated with late presentation (OR, 0.62).
• Door to balloon times were similar between groups; however, a trend towards higher 3-year all-cause mortality was observed in late presenters (16.3% vs 11.6%).

Conclusions:

• Late STEMI presentation is significantly associated with specific patient profiles including older age, female sex, and symptom onset during nighttime/early morning hours.
• Non-RCA culprit lesions are linked to earlier presentation.
• Developing targeted strategies to reduce symptom onset to door time is essential, particularly for high-risk patient groups.