Cardiovascular

System Delay and Mortality in ST-Elevation Myocardial Infarction: A Multicentre, Retrospective, Observational Study in Seoul.

Lee S, Kang H, et al. • Journal of Korean medical science • 2026

PubMed 42936979 DOI 10.3346/jkms.2026.41.e272
TL;DR

Prolonged system delays were associated with increased in-hospital mortality, highlighting the need for a comprehensive, system-level approach to reducing system delay across the entire STEMI care pathway.

Key Findings

Results

Survivors had shorter system delay components than non-survivors among STEMI patients who underwent PCI.

  • Analysis included 654 patients with STEMI who received percutaneous coronary intervention.
  • Survivors had shorter overall system delay, prehospital time, scene time, scene-to-door time, and door-to-balloon time than non-survivors.
  • Data came from the Seoul GOLDEN-time emergency medical system registry, a multicentre retrospective registry (July 2020 to December 2022).
Results

A total system delay longer than 127.5 minutes was associated with higher in-hospital mortality.

  • Adjusted odds ratio 2.07; 95% CI, 1.05-4.13.
  • System delay comprised response time, scene time, scene-to-door time, and door-to-balloon time.
  • The 127.5-minute threshold was the cutoff identified in the analysis.
Results

Prolonged prehospital time was independently associated with in-hospital mortality.

  • Adjusted odds ratio 2.35; 95% CI, 1.16-4.95.
Results

Prolonged scene time was independently associated with in-hospital mortality.

  • Adjusted odds ratio 2.61; 95% CI, 1.24-5.75.
  • Scene time was defined as ambulance on the scene to departure.
Results

Prolonged door-to-balloon time was independently associated with in-hospital mortality.

  • Adjusted odds ratio 2.20; 95% CI, 1.09-4.39.
Methods

The study population comprised STEMI patients transported by emergency medical service to an emergency department for cardiac complaints in Seoul.

  • Study period was July 2020 to December 2022.
  • The design was a multicentre, retrospective, observational registry analysis.
  • System delay was defined across response time, scene time, scene-to-door time, and door-to-balloon time.
Conclusions

The authors concluded that delays across the entire STEMI care pathway, not a single segment, should be targeted.

  • Several delay components (prehospital, scene, door-to-balloon) were each independently associated with mortality.
  • The authors call for a comprehensive, system-level approach to reducing system delay.

What This Means

This study looked at 654 people in Seoul who had a serious type of heart attack (STEMI), were taken to the hospital by ambulance, and received a procedure to reopen the blocked artery. The researchers measured how long each step of the care process took, from the first emergency call through ambulance arrival, time at the scene, the drive to the hospital, and the time from hospital arrival to the procedure. They compared these times between patients who survived their hospital stay and those who did not. Patients who survived had shorter times overall and at each step. After accounting for other factors, a total delay of more than about 127.5 minutes was linked to roughly double the odds of dying in the hospital. Long time at the scene, long total time before reaching the hospital, and long time from hospital arrival to the procedure were each linked to higher mortality, with odds about 2.2 to 2.6 times higher. This research suggests that speeding up care at every stage, not just one, may matter for survival after a STEMI. Because this was a retrospective observational study, it shows association rather than proving that shortening delays would prevent deaths. The authors argue for system-level efforts to reduce delays across the whole care pathway.

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Citation

Lee S, Kang H, Oh J, Ko B, Lee J, Yoo K, et al.. (2026). System Delay and Mortality in ST-Elevation Myocardial Infarction: A Multicentre, Retrospective, Observational Study in Seoul.. Journal of Korean medical science. https://doi.org/10.3346/jkms.2026.41.e272