Report Impact of patient delay in a modern real world STEMI network

Background: The impact of patient delay on left ventricular ejection fraction (LVEF), when system delay has per- formance that meets the current recommended guidelines, is poorly investigated. Methods: We evaluated a cohort of STEMI patients treated with primary percutaneous coronary intervention (pPCI) and with an ECG STEMI diagnosis to wire crossing time (ETW) <_120 min. Independent predictors of pre -discharge decreased LVEF (<_45%) were analyzed. Results: 490 STEMI patients with both ETW time <_120 min and available pre -discharge LVEF were evaluated. Mean age was 64.2 ? 12 years, 76.2% were male, 19.5% were diabetics, 42.7% had and anterior myocardial infarc- tion (MI), and 9.8% were in Killip class III -IV. Median time of patient's response to initial symptoms (patient delay) was 58,5 (IQR 30;157) minutes and median ETW time was 78 (IQR 62 -95) minutes. 115 patients (23.4%) had pre -discharge LVEF <_45%. At multivariable analysis independent predictors of decreased LVEF (<_45%) were anterior MI (OR 4,659, 95% CI 2,618-8,289, p b 0,001), Killip class (OR 1,449, 95% CI 1,090-1,928, p = 0,011) and patients delay above the median (OR 2,030, 95% CI 1,151 -3.578, p = 0,014). These independent predictors were con firmed in patients with ETW time <_90 min. Conclusions: When system delay meets the recommended criteria for pPCI, patient delay becomes an indepen- dent predictor of pre -discharge LVEF. These findings provide further insights into the potential optimization of STEMI management and identify a target that needs to be improved, considering that still a signi ficant proportion of patients continue to delay seeking medical care. ? 2020 Elsevier Inc. All rights reserved.