Time delays in each step from symptom onset to treatment in acute myocardial infarction: Results from a nation-wide TURKMI registry

Abstract

Objective: In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey. Methods: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT). Results: After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15-180) min and from EMS call to EMS arrival 15 (10-20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25-63) min, and median min. TIT was significantly prolonged from 151 (90-285) min to 250 (165-372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI. Conclusion:The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment.

Effects of delayed hospitalization on the 3‐year clinical outcomes of patients with or without diabetes who had non‐ST‐segment‐elevation myocardial infarction and underwent new‐generation drug‐eluting stent implantation

“…As shown in Table 2, the primary and secondary clinical outcomes were not significantly different between the SDT < 24 h and SDT ≥ 24 h groups in patients with DM, in the non-DM group, all-cause death, and CD rates were significantly higher in the SDT ≥ 24 h group than in the SDT < 24 h group. Because limited data are available, 10,30,31 and the inclusion criteria and clinical endpoints of previous studies 10,30,31 differed from those of our study, we could not provide comparative results between our study and previous studies. 30,31 More than 50% of deaths in patients with DM are associated with cardiovascular causes.…”

“…Because limited data are available, 10,30,31 and the inclusion criteria and clinical endpoints of previous studies 10,30,31 differed from those of our study, we could not provide comparative results between our study and previous studies. 30,31 More than 50% of deaths in patients with DM are associated with cardiovascular causes. 32 Patients with DM have a greater atherosclerosis burden and more diffuse and multivessel coronary artery disease.…”

Pre-hospital delay, clinical characteristics, angiographic findings, and in-hospital mortality in young and middle-aged adults with acute coronary syndrome: a single-centre registry analysis

“… 10 , 26 Older age, hypertension, diabetes, left circumflex artery as the culprit vessel, and female sex are associated with longer total ischaemic time. 10 , 27 However, the total ischaemic time is significantly influenced by medical system-related variables. Therefore, analysis of the time from symptom onset to FMC can be used to explore the patients’ role in pre-hospital delays.…”

The Impact of Emergency Department Arrival Time on Door-to-Balloon Time in Patients with ST-Segment Elevation Myocardial Infarction Receiving Primary Percutaneous Coronary Intervention

“…National guidelines have recommended that the target time for DTB should be less than 90 min [ 1 , 2 ]. To shorten DTB time, various studies have been conducted that explored the reasons for DTB-time delay [ 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Among these, the impact of off-hours or weekends on DTB-time delay represents a contentious issue [ 12 , 13 , 14 ].…”