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Time from electrocardiographic diagnosis of ST-elevation myocardial infarction to guidewire crossing in patients transferred to a hospital for primary angioplasty: factors associated with delay

Aboal J, Ramos R, Loma-Osorio P, Núñez M, Comas-Cufi M, Iglesies J, Moral S, Bosch D, Martí-Lluch R, Alves-Cabratosa L, Brugada R

Hospital Universitario Josep Trueta, Girona, Spain. ISV Research Group. Primary Care Services, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Girona, Spain. Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain. Biomedical Research Institute, Girona (IdIBGi). ICS, Girona, Spain. Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER CV), Spain.

Objective. To identify predictors of primary angioplasty delay in patients with ST-elevation myocardial infarction (STEMI) transported from out-of-hospital sites or from hospitals without percutaneous coronary intervention (PCI) suites.
Methods. Retrospective cohort study of cases between 2008 and 2018 in a university hospital receiving patients diagnosed with STEMI who required a PCI. We performed linear and multivariate regression analyses to identify factors that predicted delay in interpreting a diagnostic electrocardiogram (ECG) until the guidewire passed the lesion (diagnosis–guidewire-crossing time).
Results. A total of 1039 cases were studied; 296 patients (28.4%) had delays of more than 120 minutes between STEMI diagnosis and guidewire crossing. Factors associated with PCI delay were advanced age (odds ratio [OR] = 1.02; 95% CI, 1.01–1.04]), severe heart failure on admission (OR = 2.28; 95% CI, 1.23–4.22), history of cardiac bypass surgery (OR = 10.01; 95% CI, 2.60–41.81), out-of-hospital cardiac arrest (OR = 4.34; 95% CI, 1.84–10.32), lateral ischemia (OR, 1.64; 95% CI, 1.06–2.51), first medical attention in a hospital without a PCI suite (OR = 1.52; 95% CI, 1.05–2.21), first medical attention outside regular working hours (OR = 1.46; 95% CI, 1.06–2.02), and distance in kilometers to a PCI suite (OR = 1.04; 95% CI, 1.03–1.05).
Conclusions. Patients with STEMI who required transport to a hospital with a PCI suite experienced primary angioplasty delays. Delays were related to logistical and clinical factors as well as to infarction characteristics.

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