Factors Leading to Delays in Primary Percutaneous Intervention for Patients with ST-Elevation Myocardial Infarction

Abstract

Background: Timely primary percutaneous coronary intervention remains the most effective treatment for patients experiencing ST-elevation myocardial infarction. However, delays in performing the procedure can result in increased myocardial injury and mortality. Such delays may occur during pre-hospital, in-hospital, or patient-related stages, emphasizing the need to identify the contributing factors within specific healthcare environments, particularly in regions with limited resources. Objective: To determine the factors leading to delays in primary percutaneous intervention for patients with ST-elevation myocardial infarction. Study Design: Descriptive cross-sectional study. Duration and Place of Study: The study was conducted from February 2025 to May 2025 in the Department of Cardiology, Lady Reading Hospital, Peshawar. Methodology: A total of 176 patients aged 20–75 years with electrocardiographically confirmed ST-elevation myocardial infarction were enrolled through consecutive sampling. Delay was defined as a time interval exceeding 60 minutes between diagnosis and initiation of the procedure. Factors evaluated included patient misinterpretation of cardiac pain, diagnostic delay, transportation delay, delay in providing consent, delay due to catheterization laboratory readiness, and procedure-related delay. Results: Patient misinterpretation of cardiac pain was the most prevalent factor (62.5%), followed by delay in providing consent (59.1%) and transportation delay (52.3%). Diagnosis delay and catheterization laboratory readiness issues were less common (5.7% each), while procedural delay occurred in 15.9% of patients. A significant correlation existed between hypertension and transportation delay (p<0.01). Conclusion: Patient-related factors, particularly misinterpretation of symptoms, delay in consent, and transportation challenges, were the predominant contributors to delayed primary percutaneous coronary intervention, whereas healthcare system factors played a minor role.