Exploring the treatment delay in the care of patients with ST-elevation myocardial infarction undergoing acute percutaneous coronary intervention: a cross-sectional study

Joppe Tra, Ineke van der Wulp, Martine C. de Bruijne, Cordula Wagner

A short delay between diagnosis and treatment for patients diagnosed with ST-elevation myocardial infarction (STEMI) is vital to prevent cardiac damage and mortality. The objective of this study was to explore the treatment delay and associated factors in the management of patients diagnosed with STEMI going for percutaneous coronary intervention (PCI). In a cross-sectional multicenter study, the treatment delay (time between first electrocardiogram and start of PCI procedure) of STEMI patients in seven PCI centers in the Netherlands was measured. Data were analyzed by means of multivariable generalized linear models, accounting for a non-normally distributed outcome and clustering of patients within centers. In total, 1017 patient charts were included. The majority of the patients (78.7 %) were treated within the guideline recommended time target of 90 min. Overall, the median treatment delay was 64 min (interquartile range 47-82). A significantly prolonged delay was found among patients of whom their first electrocardiogram was performed at a general practitioner's practice (+23.9 min; 95 % confidence interval 9.9-40.8) or in-hospital (+9.5 min; 95 % confidence interval 2.5-17.3), patients requiring interhospital transfer (+14.6 min; 95 % confidence interval 7.6-22.4) or presenting with acute heart failure on admission (+17.6 min; 95 % confidence interval 7.9-28.7). Despite a short median delay between first electrocardiogram and PCI, the time targets are occasionally exceeded for patients diagnosed with STEMI. To further improve the process of care, PCI centers should focus on improving regional STEMI care networks, involving general practitioners, emergency departments and referring hospitals.