The relationship between symptom onset-to-needle time and ischemic outcomes in patients with acute myocardial infarction treated with primary PCI: Observations from Prague-18 Study

•Initial ischemic risk in ST-segment elevation myocardial infarction patients affects prognosis more than ischemic time.•Longer ischemic time increases ischemic events only in high-risk patients.•Longer ischemic time increases all-cause mortality only in high-risk patients.•Post-percutaneous coronary intervention suboptimal flow is more frequent in patients with longer ischemic time.