Delays in Treatment for STEMI Increase Risk for Heart Failure

Findings from a population-based observational study suggest that reducing time from EMS call to PCI could improve morbidity as well as mortality.


Timely reperfusion for ST-segment-elevation myocardial infarction (STEMI) dramatically reduces mortality. To evaluate how timeliness of reperfusion for STEMI relates to incident congestive heart failure (CHF), investigators studied the effects of time to primary percutaneous coronary intervention (PCI) on the risk for CHF (determined by readmission or outpatient contact) in 7952 STEMI patients in western Denmark. Patients with treatment delays >12 hours from symptom onset were excluded from the study.

The mean treatment delay (time from symptom onset to PCI) was 4.2 hours, mean patient delay (time from symptom onset to emergency medical system [EMS] call) was 2.3 hours, and mean system delay (time from EMS call to PCI) was 2.2 hours. Patients were followed for a median of 3.1 years. At 1 year, mortality was 9.2%, and the rate of incident CHF was 7.4%. Long-term cumulative incidence rates of incident CHF increased significantly with increasing length of system delay (see table).

In multivariate analysis, treatment delay was independently associated with incident CHF. In separate analyses of patient delay and system delay, only system delay remained independently associated with incident CHF.


Citation(s):

Terkelsen CJ et al. Health care system delay and heart failure in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: Follow-up of population-based medical registry data. Ann Intern Med 2011 Sep 20; 155:361.