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Original article

Vol. 150 No. 4546 (2020)

Impact of first medical contact to revascularisation time on long-term clinical outcomes in ST-segment elevation myocardial infarction patients

Cite this as:
Swiss Med Wkly. 2020;150:w20368
Published
04.11.2020

Summary

INTRODUCTION

We sought to identify predictors for a prolonged delay from first medical contact to revascularisation (FMC-R) in ST-segment elevation myocardial infarction (STEMI) patients at our institution and to assess the impact of a prolonged treatment delay on 3-year clinical outcome.

MTHODS

EVALFAST is a prospective and retrospective registry enrolling all patients admitted directly from pre-hospital care to the catheterisation laboratory at Fribourg Hospital for suspected STEMI, starting in June 2008. Relevant patient and procedural data were collected retrospectively and prospectively. Clinical follow-up was performed by phone or clinic visit. Patients were divided into two groups: FMC-R interval <90 minutes (short) and FMC-R delay of ≥90 minutes (long). The primary clinical endpoint was major adverse cardiac events (MACE) at 3-year follow-up. Secondary clinical endpoints were all-cause death and peak creatine kinase levels. Clinical outcome was compared between the two patient groups (short vs long) using Cox regression analysis.

RESULTS

Of the 406 patients enrolled between 2008 and 2014, 187 (46%) were treated with a short delay and 219 (54%) with a long delay. Age at presentation was the only predictor associated with prolonged delay (per additional year: odds ratio 1.03, 95% confidence interval 1.01–1.05, p = 0.001). The primary clinical endpoint occurred in 15% (n = 28) of patients in the short group, and 25% (n = 54) in the long group (p = 0.02). This difference was driven by higher rates of cardiac death (p = 0.08) and the need for repeat revascularisation (p = 0.11).

CONCLUSION

Increased age impacts the FMC-R delay in patients with STEMI. Patients with shorter treatment delays (<90 minutes after FMC) have significantly lower MACE rates at 3 years.

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