title: Delay from first medical contact to primary PCI and all-cause mortality: a nationwide study of patients with ST-elevation myocardial infarction.
abstract: BACKGROUND
  Early reperfusion in the setting of an ST-elevation myocardial infarction (STEMI) is of utmost importance. However, the effects of early versus late reperfusion in this patient group undergoing primary percutaneous coronary intervention (PCI) have so far been inconsistent in previous studies. The purpose of this study was to evaluate in a nationwide cohort the effects of delay from first medical contact to PCI (first medical contact [FMC]-to-PCI) and secondarily delay from symptom-to-PCI on clinical outcomes.
  
  
  RESULTS
  Using the national Swedish Coronary Angiography and Angioplasty Register (SCAAR) registry, STEMI patients undergoing primary PCI between the years 2003 and 2008 were screened for. A total of 13 790 patients were included in the FMC-to-PCI analysis and 11 489 patients were included in the symptom-to-PCI analyses. Unadjusted as well as multivariable analyses showed an overall significant association between increasing FMC-to-PCI delay and 1-year mortality. A statistically significant increase in mortality was noted at FMC-to-PCI delays exceeding 1 hour in an incremental fashion. FMC-to-PCI delays in excess of 1 hour were also significantly associated with an increase in severe left ventricular dysfunction at discharge. An overall significant association between increasing symptom-to-PCI delays and 1-year mortality was noted. However, when stratified into time delay cohorts, no symptom-to-PCI delay except for the highest time delay showed a statistically significant association with increased mortality.
  
  
  CONCLUSIONS
  Delays in FMC-to-PCI were strongly associated with increased mortality already at delays of more than 1 hour, possibly through an increase in severe heart failure. A goal of FMC-to-PCI of less than 1 hour might save patient lives.
authors.affiliation: Department of Cardiology, Lund University, Skåne University Hospital Lund, Sweden.
authors.forename: Sasha
authors.initials: S
authors.lastname: Koul
authors.forename: Pontus
authors.initials: P
authors.lastname: Andell
authors.forename: Andreas
authors.initials: A
authors.lastname: Martinsson
authors.forename: J
authors.initials: J
authors.lastname: Gustav Smith
authors.forename: Jesper
authors.initials: J
authors.lastname: van der Pals
authors.forename: Fredrik
authors.initials: F
authors.lastname: Scherstén
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
authors.forename: Bo
authors.initials: B
authors.lastname: Lagerqvist
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: ST‐segment elevation myocardial infarction; percutaneous coronary intervention