These researchers analysed data from the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry for 3,857 patients who received acute reperfusion therapy for ST-elevation myocardial infarction (STEMI) between 2015 and 2017. The analysis examined ‘patient’ and ‘system’ delays: ‘patient delay’ was defined as the time from symptom onset to first medical contact (FMC); ‘system delay’ was defined as the time from FMC until reperfusion therapy (primary percutaneous coronary intervention [PCI] or fibrinolysis). Seventy percent of the study cohort received primary PCI; 30% received fibrinolysis. In the fibrinolysis cohort, 10.5% received pre-hospital fibrinolysis. Most patients (77%) were transported to hospital by ambulance. In analyses adjusted for covariates, the likelihood of travelling to hospital by ambulance was lower among people who were older, male and presented to a hospital without a routine primary PCI service. For ambulance-transported patients, the median symptom to FMC time was 45 minutes, but this delay was >2 hours for a quarter of patients. Delays were longer for self-transported patients (a median of 97 minutes), with a quarter experiencing delays of >3 hours. In analyses adjusted for covariates, a delay between symptom onset and FMC of >1 hour was more common with older age, for those of Māori or Indian ethnicity and for those who did not call an ambulance. For ambulance-transported patients who received primary PCI, the median time was 119 minutes. For ambulance-transported patients who received fibrinolysis, the median system delay was 86 minutes, with Māori patients more often delayed than European/Other patients. Among patients who received pre-hospital fibrinolysis, the median system time was 46 minutes shorter than in those who received in-hospital fibrinolysis. For the patients who underwent rescue PCI after fibrinolysis, the median needle-to-rescue time was 237 minutes (4 hours).
