System Delays and Target Points: An Analysis of the ST-elevation MI Response Programme in a Single Centre

Abstract

Background: The goal in the treatment of ST-elevation MI (STEMI) is prompt revascularisation. This study aims to assess system delays and identify optimal target points within each step of the response program. Methods: This study included adults aged >19 years enrolled in the acute MI (AMI) registry due to STEMI and treated with emergency percutaneous coronary intervention (PCI) between January 2019 and June 2021. Door-to-balloon times and STEMI diagnosis-to-wire cross times were divided into Met and Unmet groups, and time frames were compared using the Mann–Whitney U-test. For time frames with no significant difference, the median of the Met group was adopted, whereas, for significantly different time frames, the optimal target points were chosen from the highest percentages of Met if the value was less than or equal to the target point and Unmet if the value was greater than the target point. ORs with 95% CIs from binary logistic regression were calculated to predict the Met status. Results: In all, 113 participants were analysed. Significant delays were observed in ECG to paging (p≤0.034), cardiology fellow on duty (CFOD) arrival to STEMI diagnosis (p=0.008), STEMI diagnosis to consent (p≤0.001), consent to cath lab (p≤0.001) and cath lab to puncture (p=0.003). The optimal targets in minutes were as follows: door to ECG (≤9 median), ECG to paging (≤1, OR 2.19, p=0.069), paging to CFOD arrival (≤2 median), CFOD arrival to STEMI diagnosis (≤3, OR 2.15, p=0.086), STEMI diagnosis to consent (≤10, OR 7.57, p≤0.001), consent to cath lab (≤24, OR 15.38, p≤0.001), cath lab to puncture (≤12, OR 2.68, p≤0.043). Conclusion: In a developing country and during the COVID-19 pandemic, the most significant delays in our STEMI programme occurred in obtaining consent for emergency PCI and transferring patients to the cath lab. Optimal target points for each time frame can provide concrete objectives that may increase the likelihood of achieving door-to-balloon time and STEMI diagnosis to wire cross goals.