Patient delay as bad as system delay for survival of STEMI patients

Patient delay appears to be as troublesome as system delay when it comes to the incidence of in-hospital deaths among patients with ST-segment elevation myocardial infarction (STEMI) who are undergoing primary percutaneous coronary intervention (PCI), reveals a study.

Overall, 458,260 patients from 2,529 centres were included in this analysis. The median total ischaemic time (TIT) was 4.1 hours, while system and patient delays were 1.5 and 2.1 hours, respectively.

Every 1-hour increase in TIT resulted in a 2.2-percent greater likelihood of in-hospital mortality (adjusted odds ratio [aOR], 1.022, 95 percent confidence interval [CI], 1.017–1.027). For system and patient delays, every 1-hour increase corresponded to a 2.3-percent (aOR, 1.023, 95 percent CI, 1.006–1.040) and 2.2-percent (aOR, 1.022, 95 percent CI, 1.017–1.027) rise in the odds of in-hospital deaths.

“Widespread primary PCI-capable centre, improved awareness about myocardial infarction, and regional transfer system are essential to shorten patient delay,” according to the investigators.

For this study, the investigating team screened patients with STEMI who were registered at the Nationwide Chinese Cardiovascular Association Database-Chest Pain Center from January 2017 to September 2021. TIT, system delay, and patient delay were the exposures, while in-hospital mortality was the primary outcome.

“System delay is associated with mortality in patients undergoing primary PCI for STEMI. However, the influence of patient delay has been relatively overlooked,” according to the investigators.