TY - JOUR T1 - Patient delay and benefit of timely reperfusion in ST-segment elevation myocardial infarction JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2021-001650 VL - 8 IS - 1 SP - e001650 AU - Karl Heinrich Scholz AU - Thomas Meyer AU - Björn Lengenfelder AU - Christian Vahlhaus AU - Jörn Tongers AU - Steffen Schnupp AU - Rainer Burckhard AU - Nicolas von Beckerath AU - Hans-Martin Grusnick AU - Andreas Jeron AU - Klaus Dieter Winter AU - Sebastian K G Maier AU - Michael Danner AU - Jürgen vom Dahl AU - Stefan Neef AU - Stefan Stefanow AU - Tim Friede Y1 - 2021/05/01 UR - http://openheart.bmj.com/content/8/1/e001650.abstract N2 - Background In patients with ST-segment elevation myocardial infarction (STEMI), it is unknown how patient delay modulates the beneficial effects of timely reperfusion.Aims To assess the prognostic significance of a contact-to-balloon time of less than 90 min on in-hospital mortality in different categories of symptom-onset-to-first-medical-contact (S2C) times.Methods A total of 20 005 consecutive patients from the Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) programme treated with primary percutaneous coronary intervention (PCI) were included.Results There were 1554 deaths (7.8%) with a J-shaped relationship between mortality and S2C time. Mortality was 10.0% in patients presenting within 1 hour, and 4.9%, 6.0% and 7.3% in patient groups with longer S2C intervals of 1–2 hours, 2–6 hours and 6–24 hours, respectively. Patients with a short S2C interval of less than 1 hour (S2C<60 min) had the highest survival benefit from timely reperfusion with PCI within 90 min (OR 0.27, 95% CI 0.23 to 0.31, p<0.0001) as compared with the three groups with longer S2C intervals of 1 hour<S2C≤2 hours (OR 0.44, 95% CI 0.33 to 0.59, p<0.0001), 2 hours<S2C≤6 hours (OR 0.49, 95% CI 0.38 to 0.64, p<0.0001) and 6 hours<S2C≤24 hours (OR 0.42, 95% CI 0.30 to 0.58, p<0.0001).Conclusions Timely reperfusion with a contact-to-balloon time of less than 90 min is most effective in patients presenting with short S2C intervals of less than 1 hour, but has also beneficial effects in patients with S2C intervals of up to 24 hours.Trial registration number NCT00794001.All data relevant to the study are included in the article and are available on reasonable request from the last author (TF). ER -