Treatment Delay in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary
Jinghao Sun1, Yixin Ma1, Hui Chen2
1Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China.
Insights
Prehospital delay significantly impacts ST-segment elevation myocardial infarction (STEMI) treatment outcomes in Beijing. Strategies should enhance hospital readiness, promote ambulance use, and reduce disparities to improve STEMI care.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Primary percutaneous coronary intervention (PPCI) is the gold standard for ST-segment elevation myocardial infarction (STEMI).
- Timely treatment is critical for improving STEMI patient prognosis.
- Treatment delays remain a significant challenge in STEMI management.
Purpose of the Study:
- To investigate the extent of treatment delays in STEMI patients undergoing PPCI in Beijing.
- To identify key factors influencing treatment delays, including time of admission, mode of transport, and hospital level.
Main Methods:
- A retrospective analysis of 13,445 STEMI patients who underwent PPCI across 65 hospitals in Beijing (2018-2022).
- Data on total ischemic time (TIT), symptom onset-to-door time (S2D), and door-to-balloon time (D2B) were collected.
- Mixed-effects models were used to analyze the impact of admission timing, transport mode, and hospital type on treatment delays.
Main Results:
- Median TIT, S2D, and D2B were 188, 116, and 72 minutes, respectively.
- Off-hours admissions had longer S2D but shorter D2B compared to on-hours admissions.
- Ambulance transport was associated with significantly shorter S2D and D2B compared to self-transport.
- Tertiary hospitals showed longer S2D than non-tertiary hospitals.
Conclusions:
- Prehospital delay (S2D) constitutes the largest portion of TIT in Beijing STEMI patients.
- Improving hospital preparedness and increasing ambulance utilization are crucial for reducing STEMI treatment delays.
- Addressing interhospital disparities in care is essential for optimizing STEMI management.
Background:
Primary percutaneous coronary intervention (PPCI) is the preferred treatment for ST-segment elevation myocardial infarction (STEMI). Treatment delay significantly affects the prognosis of STEMI patients.
Objectives:
The aim of this study was to investigate the treatment delay and its influencing factors for STEMI in Beijing.
Methods:
STEMI patients undergoing PPCI at 65 hospitals between 2018 and 2022 were enrolled. Treatment delays were collected and analyzed using mixed-effects models to assess the impact of admission time, arrival mode, and hospital level.
Results:
Among 13,445 individuals, median total ischemic time (TIT), symptom onset-to-door time (S2D), and door-to-balloon time (D2B) were 188 minutes (Q1-Q3: 133-288 minutes), 116 minutes (Q1-Q3: 60-200 minutes), and 72 minutes (Q1-Q3: 58-89 minutes), respectively. Compared with off-hours admissions, S2D was longer and D2B was shorter for on-hours admissions (P < 0.001 for both). Median TIT, S2D, and D2B were longer for self-transported patients than for ambulance-transported patients (P < 0.001 for all). Median TIT and S2D were shorter and D2B was longer at nontertiary hospitals than at tertiary hospitals (P < 0.001 for all). According to linear mixed-effects models adjusting for confounders, off-hours admission was linked to 6.6% shorter S2D but 11.6% longer D2B. Ambulance transport was independently associated with 9.0% shorter S2D and 10.3% shorter D2B. Treatment at tertiary hospitals was associated with 19.0% longer S2D.
Conclusions:
Despite advances in STEMI management, prehospital delay remains the dominant component of TIT in Beijing. Future strategies should focus on improving hospital preparedness, increasing ambulance use, and minimizing interhospital disparities to reduce treatment delay.
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