Determinants of Delayed Benchmark Timelines in Acute Coronary Syndrome -Insights from the Acute Coronary Syndrome Israeli Survey (ACSIS) 2010-2013 Registries - The 64th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 25-26 April 2017

Hilmi Alnsara ¹ Doron Zahger ¹ Diklah Geva ² Shlomi Matetzky ² Roy Beigel ² Zaza Iokobishvili ³ Ronny Alcalai ⁴ Shaul Atar ⁵ Avi Shimony ¹

¹Division of Cardiology, Soroka University Medical Center
²Division of Cardiology, Sheba Medical Center, Tel Hashomer
³Division of Cardiology, Rabin Medical Center, Beilinson Campus
⁴Division of Cardiology, Hadassah Medical Center
⁵Division of Cardiology, The Western Galilee Hospital in Nahariya

Background:
Treatment delays in patients with acute coronary syndrome (ACS) are related to increased morbidity and mortality. Identifying determinants of delay may help reduce time to treatment. Importantly, although current guidelines advocate the use of the first medical contact (FMC) rather than hospital admission as the moment from which delays to treatment should be monitored, the latter is still often used for quality purposes. Additionally, it is unclear whether there are gender disparities in benchmark timelines in contemporary practice. We aimed to identify potential factors associated with treatment delays with an emphasis on the impact of gender.

Methods:
We studied 3,658 ACS patients enrolled in ACSIS during 2010 and 2013. The place and time of FMC were recorded. The FMC could take place either in the ICCU, emergency department, by an ambulance team or elsewhere (e.g. physician`s office). Measured delays were FMC to ECG > 10 minutes in STEMI and NSTEMI patients, FMC to primary PCI (PPCI) >90 minutes in STEMI patients and invasive angiography > 72 hours in NSTEMI patients.

Results:
Timely ECG was performed in 48% of STEMI (median 12 minutes) and 39.8% (median 15 minutes) of NSTEMI patients without significant gender related differences. Independent determinants of delay included atypical chest pain (CP) and presentation during daytime. Among STEMI patients merely 37.5% had PPCI in less than 90 minutes (median 107 minutes) without significant gender disparities. Independent determinants of delay included atypical CP, night presentation and diabetes. Among NSTEMI patients, independent determinants of delayed coronary angiography > 72 hours since admission were atypical CP, female gender, age >75 years and renal failure.

Conclusion:
In contemporary practice there are still significant treatment delays among ACS patients highlighting the need for improvement and guidelines implementation. Identified factors in our study may facilitate targeting of specific subgroups at risk for delays.