Delay in presentation and reperfusion therapy in ST-segment elevation myocardial infarction: Gaps between practice and the guidelines

Abstract

Developing an efficient regional ST-segment elevation myocardial infarction (STEMI) network in our country has become a challenging priority. In our study, we aimed to assess the factors associated with prolonged delays to reperfusion in STEMI patients treated with Primary PCI or rescue PCI. Patients with STEMI treated with PCI from 2018 until 2019 were prospectively enrolled. Subjects were classified according to the presence of diabetes and according to the origin of the referral. Delays from chest pain onset to the diagnosis of STEMI as well as delays from the diagnosis of STEMI to reperfusion therapy were analyzed. Our population consisted of 225 patients. Baseline characteristics were similar. Diabetes was not associated with longer delays to reperfusion while the source of referral was significantly associated with longer patient delays. In fact, patients out of Sousse had received lytic therapy 5,77 ± 4,12 hours after chest pain onset versus 3,76 ± 2,5 hours for patients in Sousse; P = 0,03. Also, it took 13,09 ± 6,44 hours for patients out of Sousse to diagnose STEMI and thus, decide to perform a primary PCI versus 5,36 ± 4,84 hours for patients in Sousse; P < 0,001. For the system delays, there was no significant difference in the delay from the failure of the lytic therapy to the rescue PCI for patients in Sousse compared to patients out of Sousse (4,5 ± 4,68 hours vs. 6,5 ± 4,34 hours; P = 0,069). However, the delay from the diagnosis of STEMI in the emergency department to the primary PCI was significantly longer for patients out of Sousse (0,76 ± 0,81 hours vs. 2,5 ± 0,64 hours; P < 0,001). Shortening the time from symptoms to reperfusion is a great challenge in STEMI care. To improve the overall care of patients with STEMI particularly in our country, improvements should be focusing on how to minimize the total ischemia time.