Time to coronary angiography and revascularization in 575,247 patients with STEMI from 2012 to 2023: a retrospective population-based cohort study

TL;DR

This study shows that hospital delays for heart attack treatment in Germany improved from 2012 to 2023, but challenges remain for older patients, women, and those with comorbidities.

Contribution

The study combines hospital billing data with geographic routing to benchmark pre- and in-hospital delays in STEMI care over 11 years.

Findings

In-hospital time to angiography improved from 73.1 to 46.4 minutes between 2012 and 2023.

In-hospital mortality increased slightly despite faster treatment, linked to aging and comorbid patient populations.

Shorter total time to treatment (TTH + IHTA) reduced in-hospital mortality risk.

Abstract

Rapid primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI) reduces in-hospital and long-term mortality. This study analyzes time intervals to PPCI in STEMI, risk factors for delay of PPCI, and in-hospital mortality from 2012 to 2023.

This is a retrospective population-based analysis of hospital billing data of adult STEMI patients receiving PPCI in Germany. The time for transport to hospital (TTH) was estimated using geographic routing. The in-hospital time to angiography (IHTA) was calculated using time coding of PPCI in patient records.

A total of 575,247 patients were included. The median age was 64 years, 28.5% (164,016) were female. The population with IHTA ≤60 min increased from 44.5% (22,240/49,965) in 2012 to 57.7% (24,434/42,356) in 2023 with improved TTH + IHTA ≤120 min (56.6%, 28,280/49,965, in 2012–70.2%, 29,734/42,356, in 2023). IHTA improved from median 73.1 min (IQR 25.2–186.6) in 2012 to 46.4 min (IQR 17.5–111.6) in 2023 with a stable TTH (11.4–11.9 min). Risk factors for an IHTA >60 min included age, female sex, comorbidity, presentation out of regular hours, and low-volume hospitals. In-hospital mortality increased (8.8%, 4406/49,965, in 2012, 10.4%, 4822/46,203, in 2021, 10.1%, 4272/42,356, in 2023), paralleling a rise in patient age and comorbidity. Risk factors for in-hospital mortality included female sex, increased age, comorbidity, high-volume hospitals, intervention of multiple coronary arteries, weekend admission, and presentation out of regular hours. IHTA <40 min (90–120 min as reference) and TTH + IHTA <80 min (≥120 min as reference) reduced the risk of death.

Combining hospital billing records with geographic routing enables benchmarking of both pre- and in-hospital delays in STEMI care. In hospital delay decreased between 2012 and 2023. Important areas for improving time delays and STEMI-related mortality include the timeliness of care outside of regular hours and a focus on women, older patients, as well as individuals with comorbidities.

There was no funding for this project or this publication.

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