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The following is a summary of “Clinical Characteristics and Outcomes Stratified by Time to ST-Segment Elevation Myocardial Infarction Presentation,” published in the March 2025 issue of American Journal of Cardiology by Kakimoto et al. 

Timely medical intervention remains a cornerstone in the management of ST-segment elevation myocardial infarction (STEMI), as delays in treatment are closely associated with worse clinical outcomes. However, limited data exist regarding the clinical profiles and prognostic implications of patients who present late after symptom onset. In this study, researchers analyzed data from 719 consecutive STEMI patients enrolled in the SAGA-ACS registry, all of whom underwent percutaneous coronary intervention (PCI), to evaluate the characteristics and outcomes associated with delayed hospital presentation. Patients were stratified into early and late presentation groups based on the time from symptom onset to hospital arrival, with the median value of 2.3 hours used as the cut-off. The early presentation group had a median onset-to-door time of 1.3 hours, while the late presentation group arrived at a median of 4.8 hours after symptom onset. 

Notably, door-to-balloon times were comparable between the two groups (62.0 minutes vs. 60.5 minutes), suggesting consistent in-hospital procedural efficiency regardless of prehospital delay. Multivariable logistic regression identified several independent predictors of delayed presentation. Symptom onset during late-night to early-morning hours was significantly associated with late presentation ([OR] 2.03; 95% [CI], 1.45–2.85), as were patients aged ≥ 75 years (OR 1.56; 95% CI, 1.09–2.22) and female sex (OR 1.49; 95% CI, 1.03–2.16). In contrast, the presence of a culprit lesion in the right coronary artery (RCA) was inversely associated with late presentation (OR 0.62; 95% CI, 0.46–0.85), suggesting possible differences in symptom perception or severity depending on infarct location. Over a median follow-up duration of 2.7 years, the cumulative incidence of all-cause mortality was numerically higher in the late presentation group compared to the early group (16.3% vs. 11.6% at 3 years), although this difference did not reach statistical significance ([HR] 1.42; 95% CI, 0.97–2.07; P=0.07). 

These findings indicate that while procedural timeliness within the hospital is maintained, delayed recognition or response to symptoms remains a major barrier to optimal STEMI care. The study underscores the importance of targeting high-risk populations—particularly elderly patients, women, and those with symptoms occurring during nocturnal hours—for public health education and awareness campaigns aimed at minimizing the time from symptom onset to hospital arrival. Additionally, understanding the protective association of RCA-related infarcts with the earlier presentations may offer further insights into the interplay between symptom patterns and patient behavior. In conclusion, focused efforts to reduce prehospital delay in identified at-risk subgroups may contribute to improved long-term outcomes in patients with STEMI underwent PCI.

Source: ajconline.org/article/S0002-9149(25)00219-X/abstract