The effect of emergency department delay time on all-cause mortality of ST-segment elevation myocardial infarction patients who underwent primary percutaneous coronary intervention: does every minute affect mortality?

INTRODUCTION

The most effective therapy for ST-segment elevation myocardial infarction (STEMI) is immediate primary percutaneous coronary intervention (pPCI).

AIM

We planned this study to evaluate the effect of emergency department delay time (EDDT) on in-hospital and 1-year all-cause mortality in STEMI patients who underwent pPCI.

MATERIAL AND METHODS

Between October 2016 and May 2021, we examined 890 consecutive STEMI patients who had pPCI at our institution within 12 h of the onset of symptoms. The clinical endpoint of this study was in-hospital and 1-year all-cause mortality.

RESULTS

The cohort mostly comprised men (690 [77.5]), and their mean age was 60.7 ±13.5 years. The median EDDT was 23 (15-35) min, sheath-to-balloon (STB) time was 10 (7-13) min, and door-to-balloon (DTB) time was 34 (25-48) min. In multivariable logistic regression analysis EDDT (OR = 0.994; CI = 0.972-1.017; = 0.611) was not a predictor for in-hospital mortality. In the multivariable Cox regression analysis, EDDT (HR = 1.011, CI = 1.002-1.021, = 0.022), age (HR = 1.044, CI = 1.019-1.068, < 0.001), left ventricle ejection fraction (HR = 0.957, CI = 0.931-0.988, = 0.003), and glomerular filtration rate (HR = 0.982, CI = 0.966-0.997, = 0.016) were the independent predictors of 1-year all-cause death across all causes.

CONCLUSIONS

We found that EDDT was an independent predictor among all causes for 1-year mortality in STEMI patients who underwent pPCI but not in-hospital mortality. Reducing the time spent in the emergency department as much as possible may reduce mortality rates.