Time From Distress Call to Percutaneous Coronary Intervention and Outcomes in Myocardial Infarction

Elisabeth Helen Anna Mills; Amalie Lykkemark Møller; Thomas Engstrøm; Fredrik Folke; Frants Pedersen; Lars Køber; Filip Gnesin; Nertila Zylyftari; Stig Nikolaj Fasmer Blomberg; Kristian Kragholm; Gunnar Gislason; Britta Jensen; Freddy Lippert; Charlotte Kragelund; Helle Collatz Christensen; Mikkel Porsborg Andersen; Christian Torp-Pedersen

doi:10.1016/j.jacadv.2024.101005

Time From Distress Call to Percutaneous Coronary Intervention and Outcomes in Myocardial Infarction

Elisabeth Helen Anna Mills^*
, Amalie Lykkemark Møller
, Thomas Engstrøm
, Fredrik Folke
, Frants Pedersen
, Lars Køber
, Filip Gnesin
, Nertila Zylyftari
, Stig Nikolaj Fasmer Blomberg
, Kristian Kragholm
, Gunnar Gislason
, Britta Jensen
, Freddy Lippert
, Charlotte Kragelund
, Helle Collatz Christensen
, Mikkel Porsborg Andersen
, Christian Torp-Pedersen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

Abstract

BACKGROUND: Early percutaneous coronary intervention (PCI) is recommended for ST-segment elevation myocardial infarction (STEMI) treatment. Delays in time-to-PCI, kept within guideline recommendations, have seldom been investigated.

OBJECTIVES: The purpose of this study was to investigate the consequences of delay, due to system factors or hospital distance, for the time between last patient distress call and PCI.

METHODS: Registry-based cohort study including times of first call to medical services, admission and PCI for patients admitted with STEMI in Copenhagen, Denmark (2014-2018). The main combined outcome included death, recurrent myocardial infarction, or heart failure estimated at 30 days and 1 year from event. Outcomes according to time from call to PCI (system delay) and door-to-balloon time were standardized to the STEMI population using multivariate logistic regression.

RESULTS: In total, 1,822 STEMI patients (73.5% male, median age 63.3 years [Q1-Q3: 54.6-72.9 years]) called the emergency services ≤72 hours before PCI (1,735, ≤12 hours). The combined endpoint of 1-year cumulative incidence was 13.9% (166/1,196) for patients treated within 120 minutes of the call and 21.2% (89/420) for patients treated later. Standardized 30-day outcomes were 7.33% (95% CI: 5.41%-9.63%) for patients treated <60 minutes, and 11.1% (95% CI: 8.39%-14.2%) for patients treated >120 minutes.

CONCLUSIONS: The risk of recurrent myocardial infarction, death, and heart failure following PCI treatment of STEMI increases rapidly when delay exceeds 1 hour. This indicates a particular advantage of minimizing time from first contact to PCI.

Original language	English
Article number	101005
Number of pages	11
Journal	JACC: Advances
Volume	3
Issue number	7
DOIs	https://doi.org/10.1016/j.jacadv.2024.101005
Publication status	Published - Jul 2024
Externally published	Yes

Funding

The work was supported by the Danish Heart Foundation. This organization had no influence on the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript. Dr M & oslash;ller has received funding from Sygeforsikringen "danmark". Dr Engstr & oslash;m received speaker's fee from and is on advisory board of Abbott. Dr Folke has received NovoNordisk Research Grant NNF19OC0055142, Unrestricted Research Grant Laerdal Foundation; and teaches general practitioners resuscitation paid by AstraZeneca. Dr K & oslash;ber has received speaker honorarium from AstraZeneca, Bayer, Boehringer, and Novartis. Dr Gnes in has a relationship with DanishCardiovascular Academy-Novo Nordisk Foundation and Danish Heart Foundation. Dr Zylyftari has received funding from the European Union's Horizon 2020 Research and Innovation Program European Sudden Cardiac Arrest Network Towards Prevention, Education, New Effective Treatment, the COST Action PARQ supported by European Cooperation in Science and Technology, and Helsefonden. Dr Kragholm has received grants from The Laerdal Foundation. Dr Lippert has received unrestricted research grants from the Danish Tryg-Foundation, Laerdal Foundation, and Novo Nordic Foundation. Dr Christensen has received funding from Tryg Foundation, Laerdal, and Region Zealand Research fund. Dr Torp-Pedersen has received grants for randomized study and epidemiological study from Bayer and Novo Nordisk. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.r Cardiovascular Academy-Novo Nordisk Foundation and Danish Heart Foundation. Dr Zylyftari has received funding from the European Union's Horizon 2020 Research and Innovation Program European Sudden Cardiac Arrest Network Towards Prevention, Education, New Effective Treatment, the COST Action PARQ supported by European Cooperation in Science and Technology, and Helsefonden. Dr Kragholm has received grants from The Laerdal Foundation. Dr Lippert has received unrestricted research grants from the Danish Tryg-Foundation, Laerdal Foundation, and Novo Nordic Foundation. Dr Christensen has received funding from TrygFoundation, Laerdal, and Region Zealand Research fund. Dr Torp-Pedersen has received grants for randomized study and epidemiological study from Bayer and Novo Nordisk. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Funders
The Danish Heart Foundation

Keywords

Pci
Stemi
System delay
Time-to-treatment

Access to Document

10.1016/j.jacadv.2024.101005

Cite this

Mills, E. H. A., Møller, A. L., Engstrøm, T., Folke, F., Pedersen, F., Køber, L., Gnesin, F., Zylyftari, N., Blomberg, S. N. F., Kragholm, K., Gislason, G., Jensen, B., Lippert, F., Kragelund, C., Christensen, H. C., Andersen, M. P., & Torp-Pedersen, C. (2024). Time From Distress Call to Percutaneous Coronary Intervention and Outcomes in Myocardial Infarction. JACC: Advances, 3(7), Article 101005. https://doi.org/10.1016/j.jacadv.2024.101005

@article{09385d78b72648428a81a593e2cee35f,

title = "Time From Distress Call to Percutaneous Coronary Intervention and Outcomes in Myocardial Infarction",

abstract = "BACKGROUND: Early percutaneous coronary intervention (PCI) is recommended for ST-segment elevation myocardial infarction (STEMI) treatment. Delays in time-to-PCI, kept within guideline recommendations, have seldom been investigated.OBJECTIVES: The purpose of this study was to investigate the consequences of delay, due to system factors or hospital distance, for the time between last patient distress call and PCI.METHODS: Registry-based cohort study including times of first call to medical services, admission and PCI for patients admitted with STEMI in Copenhagen, Denmark (2014-2018). The main combined outcome included death, recurrent myocardial infarction, or heart failure estimated at 30 days and 1 year from event. Outcomes according to time from call to PCI (system delay) and door-to-balloon time were standardized to the STEMI population using multivariate logistic regression.RESULTS: In total, 1,822 STEMI patients (73.5\% male, median age 63.3 years [Q1-Q3: 54.6-72.9 years]) called the emergency services ≤72 hours before PCI (1,735, ≤12 hours). The combined endpoint of 1-year cumulative incidence was 13.9\% (166/1,196) for patients treated within 120 minutes of the call and 21.2\% (89/420) for patients treated later. Standardized 30-day outcomes were 7.33\% (95\% CI: 5.41\%-9.63\%) for patients treated <60 minutes, and 11.1\% (95\% CI: 8.39\%-14.2\%) for patients treated >120 minutes.CONCLUSIONS: The risk of recurrent myocardial infarction, death, and heart failure following PCI treatment of STEMI increases rapidly when delay exceeds 1 hour. This indicates a particular advantage of minimizing time from first contact to PCI.",

keywords = "Pci, Stemi, System delay, Time-to-treatment",

author = "Mills, \{Elisabeth Helen Anna\} and M{\o}ller, \{Amalie Lykkemark\} and Thomas Engstr{\o}m and Fredrik Folke and Frants Pedersen and Lars K{\o}ber and Filip Gnesin and Nertila Zylyftari and Blomberg, \{Stig Nikolaj Fasmer\} and Kristian Kragholm and Gunnar Gislason and Britta Jensen and Freddy Lippert and Charlotte Kragelund and Christensen, \{Helle Collatz\} and Andersen, \{Mikkel Porsborg\} and Christian Torp-Pedersen",

note = "{\textcopyright} 2024 The Authors.",

year = "2024",

month = jul,

doi = "10.1016/j.jacadv.2024.101005",

language = "English",

volume = "3",

journal = "JACC: Advances",

issn = "2772-963X",

publisher = "Elsevier B.V.",

number = "7",

}

Mills, EHA, Møller, AL, Engstrøm, T, Folke, F, Pedersen, F, Køber, L, Gnesin, F, Zylyftari, N, Blomberg, SNF, Kragholm, K, Gislason, G, Jensen, B, Lippert, F, Kragelund, C, Christensen, HC , Andersen, MP & Torp-Pedersen, C 2024, 'Time From Distress Call to Percutaneous Coronary Intervention and Outcomes in Myocardial Infarction', JACC: Advances, vol. 3, no. 7, 101005. https://doi.org/10.1016/j.jacadv.2024.101005

TY - JOUR

T1 - Time From Distress Call to Percutaneous Coronary Intervention and Outcomes in Myocardial Infarction

AU - Mills, Elisabeth Helen Anna

AU - Møller, Amalie Lykkemark

AU - Engstrøm, Thomas

AU - Folke, Fredrik

AU - Pedersen, Frants

AU - Køber, Lars

AU - Gnesin, Filip

AU - Zylyftari, Nertila

AU - Blomberg, Stig Nikolaj Fasmer

AU - Kragholm, Kristian

AU - Gislason, Gunnar

AU - Jensen, Britta

AU - Lippert, Freddy

AU - Kragelund, Charlotte

AU - Christensen, Helle Collatz

AU - Andersen, Mikkel Porsborg

AU - Torp-Pedersen, Christian

PY - 2024/7

Y1 - 2024/7

N2 - BACKGROUND: Early percutaneous coronary intervention (PCI) is recommended for ST-segment elevation myocardial infarction (STEMI) treatment. Delays in time-to-PCI, kept within guideline recommendations, have seldom been investigated.OBJECTIVES: The purpose of this study was to investigate the consequences of delay, due to system factors or hospital distance, for the time between last patient distress call and PCI.METHODS: Registry-based cohort study including times of first call to medical services, admission and PCI for patients admitted with STEMI in Copenhagen, Denmark (2014-2018). The main combined outcome included death, recurrent myocardial infarction, or heart failure estimated at 30 days and 1 year from event. Outcomes according to time from call to PCI (system delay) and door-to-balloon time were standardized to the STEMI population using multivariate logistic regression.RESULTS: In total, 1,822 STEMI patients (73.5% male, median age 63.3 years [Q1-Q3: 54.6-72.9 years]) called the emergency services ≤72 hours before PCI (1,735, ≤12 hours). The combined endpoint of 1-year cumulative incidence was 13.9% (166/1,196) for patients treated within 120 minutes of the call and 21.2% (89/420) for patients treated later. Standardized 30-day outcomes were 7.33% (95% CI: 5.41%-9.63%) for patients treated <60 minutes, and 11.1% (95% CI: 8.39%-14.2%) for patients treated >120 minutes.CONCLUSIONS: The risk of recurrent myocardial infarction, death, and heart failure following PCI treatment of STEMI increases rapidly when delay exceeds 1 hour. This indicates a particular advantage of minimizing time from first contact to PCI.

AB - BACKGROUND: Early percutaneous coronary intervention (PCI) is recommended for ST-segment elevation myocardial infarction (STEMI) treatment. Delays in time-to-PCI, kept within guideline recommendations, have seldom been investigated.OBJECTIVES: The purpose of this study was to investigate the consequences of delay, due to system factors or hospital distance, for the time between last patient distress call and PCI.METHODS: Registry-based cohort study including times of first call to medical services, admission and PCI for patients admitted with STEMI in Copenhagen, Denmark (2014-2018). The main combined outcome included death, recurrent myocardial infarction, or heart failure estimated at 30 days and 1 year from event. Outcomes according to time from call to PCI (system delay) and door-to-balloon time were standardized to the STEMI population using multivariate logistic regression.RESULTS: In total, 1,822 STEMI patients (73.5% male, median age 63.3 years [Q1-Q3: 54.6-72.9 years]) called the emergency services ≤72 hours before PCI (1,735, ≤12 hours). The combined endpoint of 1-year cumulative incidence was 13.9% (166/1,196) for patients treated within 120 minutes of the call and 21.2% (89/420) for patients treated later. Standardized 30-day outcomes were 7.33% (95% CI: 5.41%-9.63%) for patients treated <60 minutes, and 11.1% (95% CI: 8.39%-14.2%) for patients treated >120 minutes.CONCLUSIONS: The risk of recurrent myocardial infarction, death, and heart failure following PCI treatment of STEMI increases rapidly when delay exceeds 1 hour. This indicates a particular advantage of minimizing time from first contact to PCI.

KW - Pci

KW - Stemi

KW - System delay

KW - Time-to-treatment

U2 - 10.1016/j.jacadv.2024.101005

DO - 10.1016/j.jacadv.2024.101005

M3 - Article

C2 - 39129988

SN - 2772-963X

VL - 3

JO - JACC: Advances

JF - JACC: Advances

IS - 7

M1 - 101005