Delay to reperfusion in acute ST-elevation myocardial infarction: Guidelines versus real-life practice in the RESURCOR registry

Abstract

Rapid reperfusion is crucial in the treatment of acute ST-elevation myocardial infarction (STEMI). The latest STEMI guidelines from the European Society of Cardiology (ESC) recommend primary percutaneous coronary intervention (PPCI) if the delay between first medial contact (FMC) and wire passage is ≤ 120 min and fibrinolysis for delays > 120 min. With a ≤ 120 min delay from FMC to wire acceptable for PPCI, it appears that most patients would be eligible for/have access to PPCI. We sought to assess time to reperfusion in STEMI patients in a real-life registry and according to ESC guidelines. RESURCOR is an ongoing registry of all cases of acute STEMI in the north French Alps, an area that covers three French departments (Isere, Savoie, Haute-Savoie), with 1.8 million inhabitants, and a population that doubles during the summer and winter holidays. In RESURCOR, delays and care pathway for STEMI patients, from symptoms onset to reperfusion, were recorded by the physicians. Between October 2002 and December 2011, 6169 patients were enrolled in the RESURCOR registry. Of these, 2573 patients were treated with PPCI and had data recorded for delay from FMC to artery puncture; 329 patients had a contraindication to fibrinolysis and 556/2244 (25%) of the PPCI patients without a contraindication to fibrinolysis had a delay from FMC-to-artery puncture > 120 min. A total of 2768 patients were treated with fibrinolysis with recorded delays and 1381/2768 (50%) were admitted to a PCI-capable hospital with a delay from FMC-to-admission (or artery puncture in case of urgent coronary angiogram) < 120 min. When the latest ESC STEMI guidelines are applied to a real-world population, it appears that one-quarter of patients treated with PPCI would have been recommended for fibrinolysis and half of those who received fibrinolysis would have been recommended for PPCI.