Temporal trends and prognostic impact of pre-hospital delay in ST-elevation myocardial infarction—20-year observational study from the SWEDEHEART registry
Authors' conclusion
Prehospital delay is an independent predictor of mortality. Whereas no declining trend was observed the last 20 years, it is reassuring that a decrease of delay was found during the PPCI era. Women, elderly, and individuals with diabetes had consistently prolonged delay times and needs to be targeted in future interventions.
Study context
- Population
- ST-elevation myocardial infarction (STEMI) patients in Sweden, SWEDEHEART registry 1998–2017
- Participants
- 89,155 patients
- Exposure
- Associations between prehospital delay time and 14 day, 1 year, and 5 year mortality
- Outcome
- Short- and long-term mortality by prehospital delay time
Methodological detailsbased on the SWEDEHEART registry 1998-2017
- Based on the SWEDEHEART registry 1998-2017
Main finding
As reported in the abstract
- Higher short- and long-term mortality was observed with increasing prehospital delay time
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| 14 day mortality per hour of delay | 1.018 (1.011–1.025) | |
| 1 year mortality per hour of delayMultivariable adjusted; 1% | 1.011 (1.006–1.016) | |
| 5 year mortality per hour of delayMultivariable adjusted; 1% | 1.009 (1.005–1.013) | |
| 0.512Hazard ratio (log scale) |
- 14 day mortality per hour of delay: multivariable adjusted; risk increased ≈2% per hour of delay
Temporal trend of prehospital delay time · 1998-2017
- Prehospital delay time, median
- 150 min
- Prehospital delay time, IQR
- 80-302
- No significant trend of prehospital delay time during the 20 years; curve hump-shaped
- Fibrinolytic era (1998-2004): prehospital delay time significantly increased
- Primary percutaneous coronary intervention (PPCI) era (2005-17): prehospital delay time decreased
Prehospital delay time by sex, age and diabetes
- Women, elderly (≥70 years), and patients with diabetes: delay longer than their counterparts
- 25-30 min
Original publication
Temporal trends and prognostic impact of pre-hospital delay in ST-elevation myocardial infarction—20-year observational study from the SWEDEHEART registry. Eur Heart J Acute Cardiovasc Care. Published 22 December 2025. doi:10.
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