The Stent for Life initiative: Factors predicting system delay in patients with ST-segment elevation myocardial infarction

Introduction and Aims: System delay (time between first medical contact and reperfusion therapy) is an indicator of quality of primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients. This study aimed to assess changes in system delay between 2011 and 2015, and to identify its predictors. Methods: The study included 838 patients admitted to 18 Portuguese interventional cardiology centers suspected of having STEMI with less than 12 hours’ duration who were referred for primary percutaneous coronary intervention. Data were collected for a one-month period every year from 2011 to 2015. Univariate and multivariate logistic regression models were used to determine predictors of system delay. Results: No significant changes in system delay were observed during the study. Only 27% of patients had a system delay of ≤90 min. Multivariate analysis identified four predictors of system delay: age ≥75 years (OR 2.57; 95% CI 1.50-4.59; p=0.001), attending a center without pPCI (OR 4.08; 95% CI 2.75-6.10; p75 anos», «entrada num centro sem P-PCI», não «ligar para o 112-SEM» e «Região Centro» foram identificados como fatores preditores para maior atraso no sistema. O conhecimento destes fatores permitirá programar intervenções que visem reduzir o atraso do sistema e melhorar os resultados dos doentes com STEMI. Keywords: Predictive factors, System delay, ST-segment elevation myocardial infarction, Stent for Life, Palavras-chave: Fatores preditivos, Atraso do sistema, Enfarte do miocárdio com supradesnivelamento do segmento ST, Stent for Life