Temporal trends and prognostic impact of pre-hospital delay in ST-elevation myocardial infarction-20-year observational study from the SWEDEHEART registry.
European Heart Journal: Acute Cardiovascular Care · 2025-12-22 · Observational study
Abstract
AIMS: Longer ischaemic time during ST-elevation myocardial infarction (STEMI) is associated with higher mortality. However, how prehospital delay time affects outcomes and has evolved over time remains unknown. The aims were to study prognostic impact of prehospital delay time in STEMI patients during two decades in Sweden and to explore temporal trends and differences stratified by age, sex, and presence of diabetes mellitus. METHODS AND RESULTS: Observational prospective cohort study based on the SWEDEHEART registry 1998-2017. Associations between prehospital delay time and 14 day, 1 year, and 5 year mortality were estimated with Kaplan Meier and Cox regression analyses. Among 89 155 patients higher short- and long-term mortality was observed with increasing prehospital delay time. The multivariable adjusted risk of 14 day mortality increased approximately 2% per hour of delay [hazard ratio (HR) 1.018, 95% confidence interval (CI) 1.011-1.025], whereas the corresponding number for 1 and 5 year mortality was 1% (HR 1.011, 95% CI 1.006-1.016 and HR 1.009, 95% CI 1.005-1.013, respectively). No significant trend of prehospital delay time during the 20 years was observed [median 150 min, interquartile range (IQR) 80-302], as the curve was hump-shaped. During the fibrinolytic era (1998-2004), prehospital delay time significantly increased, while it decreased during the primary percutaneous coronary intervention (PPCI) era (2005-17). Consistently prolonged prehospital delay times were shown in women, elderly (≥70 years), and patients with diabetes with a delay 25-30 min longer than their counterparts. CONCLUSION: Prehospital delay is an independent predictor of mortality. Whereas no declining trend was observed the last 20 years, it is reassuring that a decrease of delay was found during the PPCI era. Women, elderly, and individuals with diabetes had consistently prolonged delay times and needs to be targeted in future interventions.
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Tags
Mortality & survival · Older adults · Sex & gender · Time intervals
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