Delays in the time from first contact with the health care system to treatment with primary percutaneous coronary intervention are linked to mortality for patients with ST-segment elevation myocardial infarction.
Researchers found that a delay of up to 60 minutes between the time of first contact with emergency medical services to the time when patients received guiding catheter insertion during PCI resulted in a long-term mortality rate of 15.4%.
When the delay increased to 61-120 minutes, the mortality rate rose to 23.3%. A delay of 121-180 minutes resulted in a long-term mortality rate of 28.1%, and a delay of 181-360 minutes had a rate of 30.8%.
After adjustment for other predictors of mortality, the system delay was still independently associated with mortality, with an adjusted hazard ratio of 1.10 per 1-hour delay, reported researchers led by Dr. Christian Juhl Terkelsen of the department of cardiology at Åarhus (Denmark) University Hospital (JAMA 2010;304:763-71).
The researchers analyzed records from 6,209 patients with STEMI or bundle-branch block MI who were admitted for primary PCI, the recommended treatment for STEMI in Denmark since 2003, during 2002-2008, at three Danish high-volume PCI centers. The median follow-up time was 3.4 years.
The Helga and Peter Komings Foundation in Denmark and the Health Research Fund of Central Denmark Region supported the study. The researchers reported no financial disclosures related to the study.