STEMI time delays: a clinical perspective

Abstract

STEMI time delays have been introduced as a performance indicator or marker of quality of care. As they are only one part of a very complex medical process, one should be aware of concomitant issues that may be overlooked or even be more important with regard to clinical outcome of STEMI patients. In this overview we try to summarise the most important ones.

Sharing primary percutaneous coronary intervention care: first experiences with South Limburg ST-elevation myocardial infarction network

“…With synchronised medical protocols, shared personnel and matched PCI equipment, regional time delays remain the most relevant quality indicator as they correlate directly with mortality rates [ 5 , 6 ]. Therefore, even though there are well-known difficulties with data registration, regional time delays were chosen to demonstrate the efficacy of the SLIM model [ 13 ].…”

“…2 ) than the advised 90 min and were clearly below the 108–120 min threshold for increased mortality rates [ 1 , 5 , 6 ]. Although we analysed an ‘all-comer’ STEMI population, the median arrival time was close to 60 min, the time point when the next significant step down in mortality rates is expected [ 5 , 6 , 13 ].…”

“…Presumably, as long as the diagnosis-to-reperfusion time recommendations of 90–120 min are respected, door-to-needle time remains a secondary indicator for STEMI networks [ 1 ]. Nevertheless, door-to-needle and door-to-balloon times are almost entirely PCI centre–dependent and are therefore important local quality indicators [ 13 ].…”

“…Some medical emergencies and conditions (e.g. out-of-hospital cardiac arrest, cardiogenic shock and ruling out of potentially life-threatening secondary diagnoses) are difficult to generalise, but have contributed to median delays and outliers [ 13 ].…”

Pre-hospital management, procedural performance and outcomes for primary percutaneous coronary intervention in ST-elevation myocardial infarction in the Netherlands: Insights from the Dutch cohort of the APPOSITION-III trial

“…A shorter time between the occurrence of ischaemia and the achievement of reperfusion results in improved myocardial salvage and is associated with better clinical outcomes [14]. Therefore, in patients presenting with STEMI, pharmacological and/or mechanical (PCI) reperfusion should be performed as early as possible [1, 15]. Besides system delay, symptom duration may accurately reflect the risk not only of myocardial injury but also long-term mortality as suggested in a recently published analysis of the HORIZONS-AMI trial [16].…”