Missed opportunity for fibrinolysis in ST-segment–elevation myocardial infarction: the nationwide France-PCI registry
Authors' conclusion
In this national STEMI network, more than half of delayed PPCI in eligible early presenters represented a persistent missed-fibrinolysis gap. Routine audit of delayed PCI and missed fibrinolysis as system-level quality metrics should guide time-based pre-hospital triage and align reperfusion with guideline-recommended targets.
Study context
- Population
- Consecutive STEMI patients enrolled ≤24 h from symptom onset in a nationwide STEMI network
- Participants
- 19,472 patients
- Exposure
- Initial reperfusion classified as timely primary percutaneous coronary intervention (PPCI) (first medical contact (FMC)-to-device ≤120 min), delayed PPCI (>120 min), or fibrinolysis
- timely PPCIn = 12,633
- delayed PPCIn = 5,895
- fibrinolysisn = 944
Methodological detailsconsecutive STEMI patients enrolled ≤24 h from symptom onset, 2014-22
- Consecutive STEMI patients enrolled ≤24 h from symptom onset
- 2014-22
Main finding
As reported in the abstract
Initial reperfusion strategy
Observational data: associations, not effects.
Further findings
| Outcome | Timely PPCI | Delayed PPCI | Fibrinolysis | |
|---|---|---|---|---|
| Missed fibrinolysis among delayed PPCI (early presenters, symptom-to-ECG ≤3 h, meeting strict fibrinolysis-eligibility criteria) | Not reported in the abstract | 55.6% | Not reported in the abstract | timely PPCI, fibrinolysis: not reported in the abstract |
Missed fibrinolysis among delayed PPCI (early presenters, symptom-to-ECG ≤3 h, meeting strict fibrinolysis-eligibility criteria)
- Proportion remained stable across years, with marked regional heterogeneity
Factors associated with reperfusion strategy
- Fibrinolysis use was favoured by mobile intensive care units, helicopter transport, and longer distance to PPCI centres
- Older age was associated with delayed PPCI without fibrinolysis
Original publication
Missed opportunity for fibrinolysis in ST-segment–elevation myocardial infarction: the nationwide France-PCI registry. Eur Heart J Qual Care Clin Outcomes. Published 13 March 2026. doi:10.
Summarised from the published abstract; every number is checked against it