Race against the Clock: Unraveling Reasons for Pre-Hospital Delays in STEMI

Abstract

Objectives: This study aimed to identify the factors contributing to delays from symptom onset to hospital presentation among patients with ST-elevation myocardial infarction (STEMI) in Karachi, Sindh. Methodology: We included 217 patients with STEMI who presented late to the emergency room (ER). Late presentation was defined as arrival more than 12 hours after the onset of chest pain. Data were collected on socio-demographic variables, cardiovascular risk factors, comorbidities, symptom characteristics, situational and cognitive factors, and initial actions taken by the patients. Results: The mean time from symptom onset to first medical contact (FMC) was 48 hours, and the mean time from FMC to arrival at a PCI-capable hospital was 15 hours. Most patients (79.7%) reported no family history of coronary artery disease (CAD), and 83.9% had no prior history of CAD. Typical chest pain was reported by 82.2% of patients. Notably, 75.4% had no knowledge of acute myocardial infarction (AMI), 76.3% failed to identify AMI symptoms, and 58.5% perceived their symptoms as controllable. Regarding first contact, 21.2% presented to local medical practitioners, 43.2% to local non-PCI-capable hospitals, and 30.5% to mobile chest pain units. Conclusions: Inadequate recognition of AMI symptoms was a key contributor to pre-hospital delays in this cohort. Public health interventions—such as community-based AMI awareness campaigns and the establishment of PCI-equipped chest pain units closer to residential areas—are essential to reduce treatment delays and improve outcomes.