Determinants of extrahospital delays in case of management of STEMI

Schroeder, Erwin [UCL] Bihin, Benoît [UCL] Gorani, Amel [UCL] Dangoisse, Vincent Guedes, Antoine [UCL] Hanet, Claude [UCL] De Canniere, Louis [UCL] Dive, Alain-Michel [UCL] Feye, Frédéric [UCL] Forêt, Frédéric [UCL] Bosie-Vasile, Mihaela [UCL] Vornicu-Darii, Diana [UCL] Morandini, Eric [UCL]

(eng) BACKGROUND : In a previous quality control assessment of the management of STEMI in our centre–a tertiary centre in a rural area–we observed a decrease in intrahospital delays over time (2004→2013) from 98→39 minutes (median) but unchanged extrahospital delays (203–220 minutes). AIM :To elucidate the determinants of these long extrahospital delays, 181 patients, undergoing PCI for STEMI (2013–2017) in our centre, were carefully interviewed. The first medical contact (FMC) allowed to assess 2 periods: onset of symptoms–FMC (period 1) and FMC–diagnosis (period 2). Results are given as mean values (median). RESULTS :In 36%, the FMC took place via the general practitioner (GP). Period 1 was associated with the type of FMC (GP: 210 ± 294, median = 79 min/EM call: 78 ± 114, median = 43 min/direct hospital admission: 222 ± 44, median = 115 min), the moment of symptoms onset (0–4 am: 198 ± 192, median 142 min/8–12 am: 96 ± 126, median 60 min), age (70–80 y: 262 ± 324, median 120 min/50–60 y: 198 ± 438, median 63 min) and the distance to our PCI centre expressed in minutes by car (< 30′: 108 ± 156, median = 60 min/ > 60′: 216 ± 288, median = 116 min). Period 2 was depending on the type of FMC (GP: 234 ± 600, median 56 min/EM call: 31 ± 29, median 22 min/direct hospital admission: 25 ± 55, median 10 min). CONCLUSION :In our local experience, FMC via the GP in case of STEMI is a major determinant for a longer extrahospital delay and should therefore be discouraged.