Predictors of Late Reperfusion in STEMI Patients Undergoing Primary Angioplasty. Impact of the Place of First Medical Contact.

INTRODUCTION AND OBJECTIVES

The benefit of primary angioplasty may be reduced if there are delays to reperfusion. Identification of the variables associated with these delays could improve health care.

METHODS

Analysis of the Codi Infart registry of Catalonia and of the time to angioplasty depending on the place of first medical contact.

RESULTS

In 3832 patients analyzed, first medical contact took place in primary care centers in 18% and in hospitals without a catheterization laboratory in 37%. Delays were longer in these 2 groups than in patients attended by the outpatient emergency medical system or by hospitals with a catheterization laboratory (P < .0001, results in median): first medical contact to reperfusion indication time was 42minutes in both (overall 35minutes); first medical contact to artery opening time was 131 and 143minutes, respectively (overall 121minutes); total ischemia time was 230 and 260minutes (overall 215minutes). First medical contact to artery opening time > 120minutes was strongly associated with first medical contact in a center without a catheterization laboratory (OR, 4.96; 95% confidence interval, 4.14-5.93), and other factors such as age, previous coronary surgery, first medical contact during evening hours, nondiagnostic electrocardiogram, and Killip class ≥ III. Mortality at 30 days and 1 year was 5.6% and 8.7% and was independently associated with age, longer delay to angioplasty, Killip class ≥ II, and first medical contact in a center with a catheterization laboratory.

CONCLUSIONS

In more than 50% of patients requiring primary angioplasty, the first medical contact occurs in centers without a catheterization laboratory, which is an important predictor of delay from diagnosis to artery opening.