Reasons for reperfusion delay in ST-elevation myocardial infarction and their impact on mortality

Abstract

Aims The impact of reperfusion delay in ST-elevation myocardial infarction (STEMI) is well known. We aimed to describe the specific reasons for delay to primary percutaneous coronary intervention (pPCI), and their impact on mortality after adjusting for confounders, using the firstmedical-contact-to-device (FMCTD) time to measure the delay.

Mortality outcomes and predictors of failed thrombolysis following STEMI thrombolysis in a non-PCI capable tertiary hospital: a 5-year analysis

“…Total ischemic time can affect STEMI patients’ prognosis as the duration of symptoms onset to reperfusion of more than 4 h is a mortality risk factor [ 38 ]. A longer total ischemia time due to reperfusion delay can be patient-related or system-related [ 44 ]. Among STEMI patients undergoing primary PCI, an Italian study has shown that patient-related delay has a higher one-year all-cause mortality than system-related delay [ 44 ].…”

“…A longer total ischemia time due to reperfusion delay can be patient-related or system-related [ 44 ]. Among STEMI patients undergoing primary PCI, an Italian study has shown that patient-related delay has a higher one-year all-cause mortality than system-related delay [ 44 ]. However, in this study, the symptoms-onset-to-thrombolysis time was not associated with FT and in-hospital mortality.…”

Coronary artery disease: novel insights in a long-standing disease

“…Rubartelli et al 8 described the specific reasons for primary percutaneous coronary intervention (PCI) delay. Among these, delays due to comorbidities, or haemodynamic instability were found as the strongest independent predictors of 1-year mortality 8 . In the last few years, the COVID-19 pandemic has enormously affected healthcare systems, with a significant impact on the STEMI care system reducing hospital admissions and prolonging revascularization time.…”

“…5 All subgroups of patients benefit from early revascularization, even those who are often undertreated in real-world practice or are more likely to have longer delays in reperfusion time, including elderly and women. 6,7 Rubartelli et al 8 described the specific reasons for primary percutaneous coronary intervention (PCI) delay. Among these, delays due to comorbidities, or haemodynamic instability were found as the strongest independent predictors of 1-year mortality.…”

Analysis of disparity in treatment delays is a major determinant of healthcare quality improvement

“…Rubartelli et al , 6 moreover, demonstrate that hemodynamic instability and relevant comorbidities are associated with worse outcomes in STEMI patients and that such a relationship is independent of the length of delay itself. In that respect, the traditional viewpoint based on the reduction of ‘compressible times’ would not solve the issue of excess mortality in these specific settings.…”