Pre-hospital delay and mortality in different age groups with acute coronary syndrome: do we have enough evidence?
Dávid Bauer1,2, Viktor Kočka1,2
1Department of Cardiology, University Hospital Královské Vinohrady, Prague, Czech Republic.
Insights
Pre-hospital delay significantly impacts acute coronary syndrome (ACS) mortality across age groups. Reducing delay, especially for STEMI and NSTEMI patients, and leveraging AI can improve outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Pre-hospital delay (p-HD) in acute coronary syndrome (ACS) critically affects timely percutaneous coronary intervention.
- The influence of patient age on p-HD and its correlation with mortality in different ACS subtypes remains incompletely understood.
- Existing data on the relationship between p-HD, age, and mortality in ACS are inconsistent.
Purpose of the Study:
- To review current evidence on how p-HD impacts mortality across diverse age groups and ACS subtypes.
- To identify specific patient subgroups within ACS where p-HD is a significant factor in mortality.
- To highlight knowledge gaps and propose future research directions for optimizing pre-hospital care in ACS.
Main Methods:
- Systematic review of existing literature on pre-hospital delay in acute coronary syndromes.
- Analysis of data stratified by age groups and ACS subtypes (STEMI, NSTEMI).
- Identification of factors contributing to p-HD and potential interventions.
Main Results:
- Pre-hospital delay significantly impacts long-term prognosis in younger ST-elevation myocardial infarction (STEMI) patients.
- Non-ST-elevation myocardial infarction (NSTEMI) patients with complex coronary lesions, often older, may benefit substantially from reduced p-HD.
- Patients with ongoing myocardial infarction (NSTEMI) experience considerable p-HD regardless of age, suggesting a need for enhanced public awareness and medical vigilance.
- Artificial intelligence (AI) integration in pre-hospital care presents a promising avenue for further p-HD reduction.
Conclusions:
- Pre-hospital delay is a critical determinant of mortality in various acute coronary syndromes, with age-dependent variations.
- Targeted interventions to reduce p-HD are crucial for improving outcomes in specific ACS populations, particularly younger STEMI and older NSTEMI patients.
- Future strategies should focus on public education, increased medical vigilance, and the adoption of innovative technologies like AI to minimize pre-hospital delays in ACS management.
Introduction:
Pre-hospital delay (p-HD) in acute coronary syndrome (ACS) influences the ability to perform percutaneous coronary intervention in a timely manner. Many factors, including age, have been identified to affect p-HD. An association between different age groups and p-HD in various ACS types is unclear. Moreover, data regarding the relationship between p-HD, age, and mortality are inconsistent.
Areas Covered:
In this review, we present current evidence of how p-HD influences mortality in various age groups and subtypes of ACS. Specific subgroups with knowledge gaps and future perspectives are identified.
Expert Opinion:
We identify specific subgroups of ACS where p-HD affects mortality in different age groups. First, p-HD may significantly affect the long-term prognosis of younger STEMI patients. Second, NSTEMI with known or presumed complex coronary lesions, often related to older age groups, might significantly benefit from p-HD reduction. Third, NSTEMI with ongoing myocardial infarction suffer from considerable p-HD, irrespective of age. These patients might benefit from reduced p-HD by improved education, public awareness, and increased medical service vigilance. Finally, incorporating artificial intelligence (AI) in pre-hospital care may provide further p-HD reduction.
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