Factors associated with delay in transfer of patients with ST-segment elevation myocardial infarction from first medical contact to catheterization laboratory: Lessons from CRAC, a French prospective multicentre registry

Summary Background It is critical to minimize the time between the first medical contact and primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Aims To identify factors associated with a delay of > 120 min between first medical contact and primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Methods Data were analysed from a regional French registry of patients undergoing coronary angioplasty for ST-segment elevation myocardial infarction  n  = 2081) were grouped according to transfer times from first medical contact to primary percutaneous coronary intervention: > 120 min; or ≤ 120 min. Independent predictors of delay were identified by univariate and multivariable analyses. Results The median transfer time from first medical contact to primary percutaneous coronary intervention was 112 min; 892 patients (42.9%) had a transfer time > 120 min. A delay of > 120 min was significantly associated with: ≥ 75 km distance from interventional cardiology centre at symptom onset (odds ratio 7.9); more than one medical practitioner involved before interventional cardiology centre (odds ratio 4.5); first admission to a hospital without an interventional cardiology centre (odds ratio 2.9); absence of emergency call (odds ratio 1.6); ≥ 90 min between symptom onset and first medical contact (odds ratio 1.3); Killip class at admission > 1 (odds ratio 1.8); lateral ischaemia (odds ratio 1.8); diabetes mellitus (odds ratio 1.6); and hypertension (odds ratio 1.3). Conclusions In ST-segment elevation myocardial infarction, a transfer time from first medical contact to primary percutaneous coronary intervention of > 120 min was associated with geographic, systemic and comorbid factors, several of which appear reasonably actionable.