Healthcare system delays increase mortality in STEMI patients
MedWire News: Patients with ST-elevation myocardial infarction (STEMI) who experience delays between first contact with the EMS and the start of PCI may increase long-term mortality in patients with STEMI may have an increased long-term mortality risk, a Danish study suggests.
"In contrast to treatment and patient delay, [healthcare] system delay was independently associated with mortality," say Christian Terkelsen (Aarhus University Hospital) and colleagues.
With treatment delay defined as the time from symptom onset to PCI initiation, and patient delay defined as time from symptom onset to contact with EMS, the team explains that "focusing on [healthcare] system delay may be more relevant, because it constitutes the total time to reperfusion modifiable by the healthcare system."
To investigate, the researchers analyzed the outcomes of 6209 Danish patients with STEMI, transported by EMS and treated with PCI within 12 hours of symptom onset.
All patients were followed up for a mean of 3.4 years.
Writing in the Journal of the American Medical Association, the team explains that after stratifying results into intervals of healthcare system delay, they observed a positive association between the length of the delay and mortality.
They report that 15.4% of the 347 patients with a healthcare system delay of 0-60 minutes, and 23.3% of the 2643 patients with a delay of 61-120 minutes died during follow-up.
Meanwhile the mortality rate was 28.1% among the 2092 patients with a healthcare system delay of 121-180 minutes, and 30.8% among those with a delay of 181-360 minutes.
After multivariate analysis and adjustment for other predictors of mortality, such as age, the team found that each hour of system delay was associated with a 10% increase in the relative risk for death.
The researchers conclude: "Increased focus on the total healthcare system delay may optimize triage of patients with STEMI and may be the key to further improving survival of these patients."
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By Lauretta Ihonor