Time From Distress Call to Percutaneous Coronary Intervention and Outcomes in Myocardial Infarction.

Background: Early percutaneous coronary intervention (PCI) is recommended for ST-segment elevation myocardial infarction (STEMI) treatment. Delays in time-to-PCI, kept within guideline recommendations, have seldom been investigated.
Objectives: The purpose of this study was to investigate the consequences of delay, due to system factors or hospital distance, for the time between last patient distress call and PCI.
Methods: Registry-based cohort study including times of first call to medical services, admission and PCI for patients admitted with STEMI in Copenhagen, Denmark (2014-2018). The main combined outcome included death, recurrent myocardial infarction, or heart failure estimated at 30 days and 1 year from event. Outcomes according to time from call to PCI (system delay) and door-to-balloon time were standardized to the STEMI population using multivariate logistic regression.
Results: In total, 1,822 STEMI patients (73.5% male, median age 63.3 years [Q1-Q3: 54.6-72.9 years]) called the emergency services ≤72 hours before PCI (1,735, ≤12 hours). The combined endpoint of 1-year cumulative incidence was 13.9% (166/1,196) for patients treated within 120 minutes of the call and 21.2% (89/420) for patients treated later. Standardized 30-day outcomes were 7.33% (95% CI: 5.41%-9.63%) for patients treated <60 minutes, and 11.1% (95% CI: 8.39%-14.2%) for patients treated >120 minutes.
Conclusions: The risk of recurrent myocardial infarction, death, and heart failure following PCI treatment of STEMI increases rapidly when delay exceeds 1 hour. This indicates a particular advantage of minimizing time from first contact to PCI.
Competing Interests: The work was supported by the 10.13039/100007405Danish Heart Foundation. This organization had no influence on the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript. Dr Møller has received funding from Sygeforsikringen “danmark”. Dr Engstrøm received speaker’s fee from and is on advisory board of Abbott. Dr Folke has received NovoNordisk Research Grant NNF19OC0055142, Unrestricted Research Grant Laerdal Foundation; and teaches general practitioners resuscitation paid by AstraZeneca. Dr Køber has received speaker honorarium from AstraZeneca, Bayer, Boehringer, and Novartis. Dr Gnesin has a relationship with Danish Cardiovascular Academy-Novo Nordisk Foundation and Danish Heart Foundation. Dr Zylyftari has received funding from the European Union’s Horizon 2020 Research and Innovation Program European Sudden Cardiac Arrest Network Towards Prevention, Education, New Effective Treatment, the COST Action PARQ supported by European Cooperation in Science and Technology, and Helsefonden. Dr Kragholm has received grants from The Laerdal Foundation. Dr Lippert has received unrestricted research grants from the Danish TrygFoundation, Laerdal Foundation, and Novo Nordic Foundation. Dr Christensen has received funding from TrygFoundation, Laerdal, and Region Zealand Research fund. Dr Torp-Pedersen has received grants for randomized study and epidemiological study from Bayer and Novo Nordisk. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(© 2024 The Authors.)