title: Trends in treatment delays for patients with acute ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.
abstract: BACKGROUND
  Treatment delay is an important prognostic factor for patients with acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). We aimed to determine recent trends in these delays and factors associated with longer delays.
  
  
  METHODS
  We compared two datasets collected in Helsinki University Central Hospital in 2007-2008 (HUS-STEMI I) and 2011-2012 (HUS-STEMI II), a total of 500 patients treated with primary PCI within 12 hours of the onset of symptoms.
  
  
  RESULTS
  Delays of the emergency medical system (EMS) were longer in HUS-STEMI I than II (medians 81 vs. 67 min, respectively, p < 0.001). Although door-to-balloon times were longer in the later dataset (33 vs. 48 min, p < 0.001) most of the patients (75.3% vs. 62.8%, respectively, p = 0.010) were treated within the recommendation (<60 min) of the European Society of Cardiology (ESC). In HUS-STEMI II, patient arrival at the hospital during off-hours was associated with longer door-to-balloon time (40 and 57.5 min, p = 0.001) and system delay (111 and 127 min, p = 0.009). However, in HUS-STEMI I, arrival time did not impact the delays. Longer system delay was associated with higher mortality rates.
  
  
  CONCLUSIONS
  Though the delays inside the hospital have increased they are still mostly within the ESC guidelines. Still, only about half of the patients are treated within a system delay of recommended two hours. Albeit our results are good in comparison with previous studies, further efforts for decreasing the delays particularly within the EMS should be established.
authors.forename: Salla
authors.initials: S
authors.lastname: Helve
authors.forename: Juho
authors.initials: J
authors.lastname: Viikilä
authors.forename: Mika
authors.initials: M
authors.lastname: Laine
authors.forename: Jyrki
authors.initials: J
authors.lastname: Lilleberg
authors.forename: Ilkka
authors.initials: I
authors.lastname: Tierala
authors.affiliation: Heart and Lung Center, Cardiology, Helsinki University Central Hospital, P,O, Box 340, FI-00029 Helsinki, Finland. tuomo.nieminen@iki.fi.
authors.forename: Tuomo
authors.initials: T
authors.lastname: Nieminen
mesh_terms: D039602:After-Hours Care / Q000639:trends; D000368:Aged; D004632:Emergency Medical Services / Q000639:trends; D005260:Female; D005387:Finland; D019983:Guideline Adherence; D006297:Health Services Accessibility / Q000639:trends*; D006785:Hospitals, University / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment / Q000639:trends*; D016896:Treatment Outcome