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Impact of age and comorbidities on treatment delays in acute coronary syndrome: a retrospective analysis
Session:
Sessão de Posters 46 - Síndromes coronárias agudas: vias, atrasos e impacto das recomendações
Speaker:
Marta Paralta De Figueiredo
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
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Authors:
António Maria Fervença Rocha Almeida; Marta Figueiredo; Rafael Viana; Rita Louro; Raquel Silva; Diogo Brás; David Neves; Ângela Bento; Renato Fernandes; Lino Patrício
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION</strong>: Ischaemic heart disease is the most common cause of death. Approximately one-third of patients hospitalised for acute coronary syndrome (ACS) are over 75 years of age but these patients are underrepresented in randomised controlled trials, despite mortality rate being twice as high. The mortality in patients presenting with an ACS is associated with many factors such as the time delay to treatment. Hence, we aim to analyse the response time and delays in the emergent coronary referral pathway for our centre taking age in consideration.</span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS and RESULTS:</strong> We conducted a retrospective analysis of 833 consecutive patients admitted for primary percutaneous coronary angioplasty between January 2022 and April 2025. The median age was 64 ± 14 years, with 73% of participants being male. Key comorbidities included diabetes (27%), dyslipidemia (39%), hypertension (56%), smoking (48%), family history of cardiac disease (5%), and prior myocardial infarction (12%). Most patients (87%) presented in Killip class I. The time variables analyzed included patient delay, ECG delay, diagnostic delay, transport delay, home delay, and procedure time. Additional variables were door-in-door-out time, diagnosis-to-wire time, first medical contact (FMC) to wire, and total ischemia time.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients over 75 years old were less frequently male (60% vs. 77%, p<0.001), had less smoking history (14% vs. 58%, p<0.001), and less family history of cardiac disease (1% vs. 6%, p=0.006). Conversely, they exhibited more diabetes (33% vs. 25%, p=0.030), dyslipidemia (48% vs. 36%, p=0.003), and hypertension (70% vs. 51%, p<0.001). N</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#374151">o differences were found regarding median patient delay (106 min vs. 101 min), transport delay (105 min vs. 86 min), home delay (2 min vs. 2 min), diagnosis-to-wire time (150 min vs. 122 min), or procedure time (61 min vs. 57 min). However, older individuals demonstrated significantly longer ECG delay (22 min vs. 14 min, p<0.001), diagnostic delay (40 min vs. 22 min, p<0.001), door-in-door-out time (150 min vs. 76 min, p<0.001), FMC to wire time (262 min vs. 174 min, p<0.001), and total ischemia time (466 min vs. 322 min, p<0.001). </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#374151">After adjustment for cardiovascular risk factors, age over 75 years was identified as an independent predictor of prolonged ECG delay (p=0.018), door-in-door-out time (p=0.004), and FMC to wire time (p=0.001).</span></span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">CONCLUSIONS: </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This study shows that our population is significantly delayed compared to the ESC guidelines. Older patients experienced notably longer delays in ECG acquisition, diagnostic processes, and overall treatment times. Factors like diabetes, dyslipidemia, and hypertension were more prevalent in this age group, further complicating timely care. Addressing these delays through targeted interventions focusing on older patients could help reduce treatment times and improve clinical outcomes for those affected by acute coronary syndrome.</span></span></p>
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