TY - JOUR T1 - Patient and system delays in the treatment of acute coronary syndrome JO - Revista Portuguesa de Cardiologia (English edition) T2 - AU - Viana,Marta AU - Laszczyńska,Olga AU - Araújo,Carla AU - Borges,Andreia AU - Barros,Vítor AU - Ribeiro,Ana Isabel AU - Dias,Paula AU - Maciel,Maria Júlia AU - Moreira,Ilídio AU - Lunet,Nuno AU - Azevedo,Ana SN - 21742049 M3 - 10.1016/j.repce.2019.07.007 DO - 10.1016/j.repce.2019.07.007 UR - https://revportcardiol.org/en-patient-system-delays-in-treatment-articulo-S2174204920301616 AB - IntroductionEarly reperfusion for patients with ST-segment elevation myocardial infarction (STEMI) is indicated by the European Society of Cardiology, while a timely invasive strategy is recommended for patients with high-risk and intermediate-risk non-ST-elevation acute coronary syndromes (NSTE-ACS). This study aims to assess patient and system delays according to diagnosis and risk profile, and to identify predictors of prolonged delay. MethodsWe assembled a cohort of patients (n=939) consecutively admitted to the cardiology department of two hospitals, one in the metropolitan area of Porto and one in the north-east region of Portugal, between August 2013 and December 2014. ResultsThe proportion of patients with time from symptom onset to first medical contact (FMC) ≥120 min was highest among high-risk NSTE-ACS (57.7%), followed by intermediate-risk NSTE-ACS (52.1%) and STEMI (43.3%). Regardless of diagnosis and risk stratification, use of own transportation and inability to interpret cardiac symptoms correctly were associated with prolonged delays. Regarding system delays, we found that 78.0% of patients with STEMI and 65.8% of patients with high-risk NSTE-ACS were treated in a timeframe exceeding the recommended limits. Admission to a non-percutaneous coronary intervention-capable hospital, admission on weekends and complications at admission were associated with prolonged delays to treatment. ConclusionsDue to both patient and system delays, a large proportion of STEMI and high-risk NSTE-ACS patients still fail to have access to timely reperfusion. ER -