Causes of delay and associated mortality in patients transferred with ST-segment-elevation myocardial infarction

Michael D. Miedema, Marc C. Newell, Sue Duval, Ross F. Garberich, Chauncy B. Handran, David M. Larson, Steven Mulder, Yale L. Wang, Daniel L. Lips, Timothy D. Henry

Research output: Contribution to journalArticlepeer-review

88 Scopus citations

Abstract

Background-: Regional ST-segment-elevation myocardial infarction systems are being developed to improve timely access to primary percutaneous coronary intervention (PCI). System delays may diminish the mortality benefit achieved with primary PCI in ST-segment-elevation myocardial infarction patients, but the specific reasons for and clinical impact of delays in patients transferred for PCI are unknown. Methods and Results-: This was a prospective, observational study of 2034 patients transferred for primary PCI at a single center as part of a regional ST-segment-elevation myocardial infarction system from March 2003 to December 2009. Despite long-distance transfers, 30.4% of patients (n=613) were treated in ≤90 minutes and 65.7% (n=1324) were treated in ≤120 minutes. Delays occurred most frequently at the referral hospital (64.0%, n=1298), followed by the PCI center (15.7%, n=317) and transport (12.6%, n=255). For the referral hospital, the most common reasons for delay were awaiting transport (26.4%, n=535) and emergency department delays (14.3%, n=289). Diagnostic dilemmas (median, 95.5 minutes; 25th and 75th percentiles, 72-127 minutes) and nondiagnostic initial ECGs (81 minutes; 64-110.5 minutes) led to delays of the greatest magnitude. Delays caused by cardiac arrest and/or cardiogenic shock had the highest in-hospital mortality (30.6%), in contrast with nondiagnostic initial ECGs, which, despite long treatment delays, did not affect mortality (0%). Significant variation in both the magnitude and clinical impact of delays also occurred during the transport and PCI center segments. Conclusions-: Treatment delays occur even in efficient systems for ST-segment-elevation myocardial infarction care. The clinical impact of specific delays in interhospital transfer for PCI varies according to the cause of the delay.

Original languageEnglish (US)
Pages (from-to)1636-1644
Number of pages9
JournalCirculation
Volume124
Issue number15
DOIs
StatePublished - Oct 11 2011

Keywords

  • angioplasty, balloon, coronary
  • delays
  • delivery of health care
  • myocardial infarction

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