Abstract 14166: Impact of Patient- and System-Level Delays on Reperfusion Among ST-Elevation Myocardial Infarction Patients

• Published in: Circulation (New York, N.Y.) N.Y.), 2018-11, Vol.138 (Suppl_1 Suppl 1), p.A14166-A14166
• Main Authors: Wenner, Joshua B, Wong, Graham C, Cairns, John A, Perry-Arnesen, Michele, Tocher, Wendy J, Mackay, Martha H, Singer, Joel, Lee, Terry, Fordyce, Christopher B
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

IntroductionST-elevation myocardial infarction (STEMI) patients presenting to primary percutaneous coronary intervention (PPCI)-capable hospitals often experience reperfusion delays.HypothesisSpecific intervals within first medical contact to device time (FMC-DT) may interact with patient/system-level factors and contribute to reperfusion delays.MethodsWe analyzed all consecutive STEMI patients treated at 2 PPCI-capable hospitals between 06/2007-03/2016. We excluded those who did not receive successful PPCI or presented with cardiac arrest. We compared specific system delay intervals, patient characteristics, and in-hospital outcomes among those who received timely (FMC-DT ≤90/≤120 min) vs. delayed (FMC-DT >90/>120 min) PPCI.ResultsOur cohort consisted of 1579 patients; 1127 (71%) presented via emergency health services (EHS), 142 (9%) transferred from a non-PCI hospital, and 310 (29%) self-presented to a PPCI-capable hospital. The majority of patients in each cohort were male, with a significantly greater proportion of females receiving delayed reperfusion; there were no other differences in baseline clinical characteristics. Timely reperfusion occurred in 47% direct-EHS, 16% transfers, and 33% self-presenters. Each interval from FMC to device was significantly prolonged in the delayed vs. timely group across all three cohorts, excepting vascular access time [Figure]. Emergency department (ED) dwell contributed most to the difference in FMC-DT within each cohort (86% EHS-direct; 80% transfers; 92% self-presenters). In the EHS-direct cohort, longer reperfusion and ED dwell times were significantly associated with mortality (delayed 7.7% vs timely 3.8%; p