Time to coronary angiography and revascularization in 575,247 patients with STEMI from 2012 to 2023: a retrospective
Paulina E Stürzebecher1, Ulrich Laufs1, Philip Baum2
1Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, 04103, Germany.
Insights
Rapid primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) improved over time, but in-hospital mortality rose. Addressing delays outside regular hours and focusing on high-risk groups can further reduce STEMI mortality.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- ST-elevation myocardial infarction (STEMI) requires rapid treatment with primary percutaneous coronary intervention (PPCI) to reduce mortality.
- Analysis of time intervals, risk factors for delays, and in-hospital mortality in STEMI patients receiving PPCI between 2012 and 2023.
Purpose of the Study:
- To analyze trends in PPCI time intervals for STEMI patients in Germany.
- To identify risk factors associated with delays in PPCI.
- To examine in-hospital mortality rates and their correlation with treatment timeliness and patient demographics.
Main Methods:
- Retrospective population-based analysis of hospital billing data for adult STEMI patients undergoing PPCI in Germany.
- Estimation of transport time to hospital (TTH) using geographic routing.
- Calculation of in-hospital time to angiography (IHTA) using PPCI time coding.
Main Results:
- Over 575,000 patients were analyzed; in-hospital delay (IHTA) decreased significantly from 2012 to 2023, with improved overall treatment times (TTH + IHTA).
- Despite improved timeliness, in-hospital mortality increased, paralleling rises in patient age and comorbidity.
- Risk factors for delays included older age, female sex, comorbidities, out-of-hours presentation, and low-volume hospitals. Mortality risks were higher for women, older patients, those with comorbidities, and weekend/out-of-hours admissions.
Conclusions:
- While in-hospital delays in PPCI for STEMI have decreased, overall mortality has risen, necessitating further improvements.
- Targeting care outside regular hours and focusing on vulnerable populations (women, elderly, those with comorbidities) are crucial for reducing STEMI mortality.
Background:
Rapid primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI) reduces in-hospital and long-term mortality. This study analyzes time intervals to PPCI in STEMI, risk factors for delay of PPCI, and in-hospital mortality from 2012 to 2023.
Methods:
This is a retrospective population-based analysis of hospital billing data of adult STEMI patients receiving PPCI in Germany. The time for transport to hospital (TTH) was estimated using geographic routing. The in-hospital time to angiography (IHTA) was calculated using time coding of PPCI in patient records.
Findings:
A total of 575,247 patients were included. The median age was 64 years, 28.5% (164,016) were female. The population with IHTA ≤60 min increased from 44.5% (22,240/49,965) in 2012 to 57.7% (24,434/42,356) in 2023 with improved TTH + IHTA ≤120 min (56.6%, 28,280/49,965, in 2012-70.2%, 29,734/42,356, in 2023). IHTA improved from median 73.1 min (IQR 25.2-186.6) in 2012 to 46.4 min (IQR 17.5-111.6) in 2023 with a stable TTH (11.4-11.9 min). Risk factors for an IHTA >60 min included age, female sex, comorbidity, presentation out of regular hours, and low-volume hospitals. In-hospital mortality increased (8.8%, 4406/49,965, in 2012, 10.4%, 4822/46,203, in 2021, 10.1%, 4272/42,356, in 2023), paralleling a rise in patient age and comorbidity. Risk factors for in-hospital mortality included female sex, increased age, comorbidity, high-volume hospitals, intervention of multiple coronary arteries, weekend admission, and presentation out of regular hours. IHTA <40 min (90-120 min as reference) and TTH + IHTA <80 min (≥120 min as reference) reduced the risk of death.
Interpretation:
Combining hospital billing records with geographic routing enables benchmarking of both pre- and in-hospital delays in STEMI care. In hospital delay decreased between 2012 and 2023. Important areas for improving time delays and STEMI-related mortality include the timeliness of care outside of regular hours and a focus on women, older patients, as well as individuals with comorbidities.
Funding:
There was no funding for this project or this publication.
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