Acute myocardial infarction in the Covid-19 era: incidence, clinical characteristics and in-hospital outcomes – a multicenter registry

Abstract Background A reduction in acute myocardial infarction (AMI) hospitalizations during the coronavirus pandemic has been previously documented. We aimed to describe the characteristics and in-hospital outcomes of AMI patients during the Covid-19 era compared to a recent previous registry. Methods We conducted a prospective, multicenter, observational study involving 13 intensive cardiac care units (ICCUs) to evaluate consecutive AMI patients admitted throughout an 8-week period during the Covid-19 outbreak. Data were compared to the corresponding period in 2018 using an acute coronary syndrome survey conducted in all ICCUs in Israel. The primary end-point was defined as a composite of sustained ventricular arrhythmia, pulmonary congestion, and/or in-hospital mortality. Results The study cohort comprised 1466 patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with ST-elevation MI (STEMI): 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. No differences were detected in the admission rate of patients between the two study periods. STEMI patients admitted during the Covid-19 period tended to have fewer co-morbidities, but a higher Killip class (p value = 0.03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122–292) in 2018 to 290 minutes (IQR 161–1080, p<0.001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint of heart failure, malignant arrhythmia, or death in the multivariable logistic regression model (OR 1.63, 95% CI 1.02–2.65, p value = 0.05). Conclusion While the admission rate of AMI and STEMI in Israel remained similar during both the Covid-19 era and the corresponding period in 2018, total ischemic time extended significantly during the Covid-19 period, which translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by a grant from a Fefer foundation for medical research

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Acute myocardial infarction in the Covid-19 era: Incidence, clinical characteristics and in-hospital outcomes—A multicenter registry

PLoS ONE ◽

10.1371/journal.pone.0253524 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253524

Author(s):

Alexander Fardman ◽

Doron Zahger ◽

Katia Orvin ◽

Daniel Oren ◽

Natalia Kofman ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Severe Disease ◽

P Value ◽

Study Cohort ◽

Hospital Outcomes ◽

Ischemic Time ◽

Coronary Syndrome ◽

Mechanical Complications ◽

Increased Risk

Background We aimed to describe the characteristics and in-hospital outcomes of ST-segment elevation myocardial infarction (STEMI) patients during the Covid-19 era. Methods We conducted a prospective, multicenter study involving 13 intensive cardiac care units, to evaluate consecutive STEMI patients admitted throughout an 8-week period during the Covid-19 outbreak. These patients were compared with consecutive STEMI patients admitted during the corresponding period in 2018 who had been prospectively documented in the Israeli bi-annual National Acute Coronary Syndrome Survey. The primary end-point was defined as a composite of malignant arrhythmia, congestive heart failure, and/or in-hospital mortality. Secondary outcomes included individual components of primary outcome, cardiogenic shock, mechanical complications, electrical complications, re-infarction, stroke, and pericarditis. Results The study cohort comprised 1466 consecutive acute MI patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with STEMI: 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. Although STEMI patients admitted during the Covid-19 period had fewer co-morbidities, they presented with a higher Killip class (p value = .03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122–292) in 2018 to 290 minutes (IQR 161–1080, p < .001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint in the multivariable regression model (OR 1.65, 95% CI 1.03–2.68, p value = .04). Furthermore, the rate of mechanical complications was four times higher during the Covid-19 era (95% CI 1.42–14.8, p-value = .02). However, in-hospital mortality remained unchanged (OR 1.73, 95% CI 0.81–3.78, p-value = .16). Conclusions STEMI patients admitted during the first wave of Covid-19 outbreak, experienced longer total ischemic time, which was translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events, compared with parallel period.

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Clinical and Anamnestic Characteristics of Acute Coronary Syndrome after Suffering COVID-19

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1612 ◽

2021 ◽

Vol 76 (5S) ◽

pp. 533-538

Author(s):

Natalia V. Orlova ◽

Valerij V. Lomajchikov ◽

Tatyana I. Bonkalo ◽

Grigorij A. Chuvarayan ◽

Yana G. Spiryakina ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Coronary Vessels ◽

Thrombin Time ◽

Laboratory Parameters ◽

Coronary Syndrome ◽

Increased Risk

Background. COVID-19 increases the risk of developing thromboembolic complications, including acute myocardial infarction, in the acute period of the disease. The long-term consequences of COVID-19 are poorly understood. At the same time, the available data on an increased risk of acute coronary syndrome after infectious diseases allow us to make an assumption about a similar risk in COVID-19. The aim of the study was to study the anamnestic and laboratory diagnostic data in patients with acute coronary syndrome after COVID-19. Methods. The study included 185 patients with acute coronary syndrome who were admitted to the State Clinical Hospital No. 13 in Moscow in the period from May to December 2020. 2 groups were identified: group 1 109 patients with ACS who had previously suffered COVID-19, group 2 76 patients with ACS without COVID-19 in the past. The patients were collected anamnesis, including: the fact of smoking and alcohol consumption, heredity, previous diseases, including diabetes mellitus, acute myocardial infarction, previously performed PCI. Information about the COVID-19 infection has been collected (the duration of the disease, the course of the disease). A clinical and laboratory examination was conducted, including the determination of body mass index (BMI), examination for antibodies to COVID-19, determination of the lipid profile level (total cholesterol, LDL, HDL, triglycerides), blood glucose level, C-RB. The analysis was performed on automatic biochemical analyzers Hitachi-902, 912 (Roche Diagnostics, Japan). All patients underwent coronary angiography. Results. In patients with ACS with previously transferred COVID-19, the development of the disease occurred at a younger age compared to patients without transferred COVID-19. Among the patients with COVID-19, body weight was significantly lower, there were fewer smokers, concomitant type 2 diabetes mellitus and transferred ONMC were less common. In laboratory parameters, lower triglyceride levels were observed in patients with ACS with COVID-19 compared with those of patients without COVID-19. In the laboratory parameters of blood clotting in patients with ACS with COVID-19, higher APTT, thrombin time, fibrinogen level, D-dimer were noted. The indicated laboratory parameters in the groups had statistically significant differences. In ACS patients with a previous COVID-19, compared with patients without COVID-19, the lesion of 2 or more coronary vessels was more common in the anamnesis. Conclusion. According to the results of our study, it was revealed that multivessel coronary artery damage in patients after COVID-19 in comparison with patients without COVID-19 develops significantly more often, while these patients are significantly less likely to have DM and previously suffered ONMC, the level of TG is significantly lower.

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Terminal QRS Distortion on Admission ECG as a Predictor for Major Cardiovascular Adverse Events during Hospitalization in Patient with ST Segment Elevation Myocardial Infarction in Haji Adam Malik General Hospital

ACI (Acta Cardiologia Indonesiana) ◽

10.22146/jaci.v6i2.628 ◽

2020 ◽

Vol 6 (2) ◽

pp. 121-126

Author(s):

Kamal Kharrazi Ilyas ◽

Zainal Safri ◽

Harris Hasan ◽

Zulfikri Mukhtar ◽

Nizam Zikri Akbar ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Major Adverse Cardiovascular Event ◽

Major Adverse Cardiovascular Events ◽

P Value ◽

Significant Variable ◽

S Wave ◽

Adverse Cardiovascular Event ◽

St Segment Elevation ◽

Coronary Syndrome

Background: Mortality in patient with acute myocardial infarction has decreased due to evolution in management system in patient with acute coronary syndrome, but mortality rate during hospitalization remains high, especially STEMI. Electrocardiography (ECG) has a role for diagnosing and predict prognosis in acute myocardial infarction. Terminal QRS distortion defined as J point elevation more than 50% of R wave in lead with qR configuration and/or loss of S wave with RS configuration. Changes of terminal QRS segment believed to be caused by electrical conduction elongation in Purkinje fiber or myocardial ischemic zone that represent severe ischemia. The purpose of this study is to assess the role of terminal QRS distortion as one of the parameter to predict major adverse cardiovascular events during hospitalization in ST elevation myocardial infarction in RSUP H. Adam Malik Methods: This is a ambispective observational study consist of STEMI patients who were hospitalized from Mei 2019 to September 2019. All subjects diagnosed with STEMI and already fulfilled the inclusion and exclusion criterias. The terminal QRS distortion on the ECGs was assessed when the patient came to emergency departement. Then during hospitalization, the patients will undergo intervention and then observed during hospitalization for MACE occurrence. Results: Of the 78 STEMI patients, 44 people had terminal QRS distortion and 34 did not have terminal QRS distortion. In group with terminal QRS distortion, 27 people experiences MACE. From the correlation analysis, there is positive correlation between terminal QRS distortion with MACE with correlation coefficient 0.317 (p value < 0.001). Multivariate analysis for most significant variable for MACE occurrence shows that terminal QRS distortion can predict MACE (OR 3.66 [1.317-10.166], 95% CI, p = 0.013) Conclusion: Terminal QRS distortion found in ECG at admission in STEMI patient correlate with major adverse cardiovascular event during hospitalization.

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Acute myocardial infarction,arterial thrombosis and thrombophilia in young patients

Bulgarian Cardiology ◽

10.3897/bgcardio.26.e58770 ◽

2020 ◽

Vol 26 (4) ◽

pp. 26-39

Author(s):

Ivo Petrov ◽

Naydenka Zlatareva-Gronkova ◽

Todor Kundurdjiev ◽

Viktoria Dimitrova

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Arterial Thrombosis ◽

Young Patients ◽

Specific Treatment ◽

Premature Coronary Artery Disease ◽

Thrombotic Risk ◽

Coronary Syndrome ◽

Increased Risk ◽

Blood Coagulation Abnormality

Acute coronary syndrome (ACS) represent emergency state in an intensive cardiovascular care unit, which implies immediate and speciﬁc treatment. Of peculiar interest for cardiologists are young patients with acute myocardial infarction (AMI). The family history taking for premature coronary artery disease (CAD) and establishment of genetic factors, responsible for coagulation, both are on target for this group of patients. Gold standard for AMI diagnosis is coronary angiography (CA), which usually implies endovascular treatment (EVT). When coronary thrombus formation is found in young patients, different diagnostic opportunities are possible. Thrombophilia (TF) represents blood coagulation abnormality resulting in an increased risk of thrombosis. It could affect different sections of the cardiovascular system, most commonly venous, but also arterial. This clinical condition could be conﬁrmed by performing laboratory genetic tests. We studied a group of forty-one young patients with ﬁrst appearance of ACS ≤ 55 years old included for a ﬁve-year period. All of them were evaluated with CA and received EVT. According to the thrombotic risk, we deﬁned a high-risk group, treated with anticoagulant (AC) on top of dual antiplatelet therapy (DAPT). The patients were followed-up for recurrent ischemic and bleeding events. We performed laboratory tests for the most frequent TF gene mutations in Bulgarian population. There is a conﬂicting data about this issue in different ethnic origins. The aim of our study is to estimate the possible relationship between the TF and the arterial thrombosis in young ACS patients, to deﬁ ne speciﬁc treatment strategies, improving the prognosis of the patients.

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Gout as a risk factor for acute myocardial infarction: evidence from competing risk model analysis

Journal of Investigative Medicine ◽

10.1136/jim-2020-001714 ◽

2021 ◽

pp. jim-2020-001714

Author(s):

Chia-Luen Huang ◽

Tai-Wen Wang ◽

Yong-Chen Chen ◽

Je-Ming Hu ◽

Po-Ming Ku ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Risk Model ◽

Epidemiological Studies ◽

Competing Risk ◽

Study Cohort ◽

Research Database ◽

Competing Risk Model ◽

Increased Risk ◽

Future Work

Chronic inflammation, a hallmark of gout, is implicated in the pathogenesis of atherosclerosis. Thus, in theory, gout can be expected to increase the risk of acute myocardial infarction (AMI). Yet, results from several epidemiological studies have been inconclusive. A retrospective cohort study was conducted using the National Health Insurance Research Database of Taiwan dated from 2000 to 2013. The study cohort comprised 3581 patients with gout (the gout cohort) and 14,324 patients without gout (the non-gout cohort). The primary outcome was the incidence of AMI. To estimate the effect of gout on the risk of AMI, the Lunn-McNeil competing risk model was fitted to estimate cause-specific hazard ratios (HRs) and their 95% confidence intervals (CIs). The cumulative incidence of AMI was significantly higher in the gout cohort than in the non-gout cohort, resulting in an adjusted HR of 1.36 (95% CI 1.04 to 2.76). Further, HRs of gout with incident AMI were higher in patients without hypertension, diabetes mellitus, or hyperlipidemia (ranging from 1.63 to 2.09) than in those with each of these comorbidities (ranging from 0.95 to 1.13). The results of this study suggest that patients with gout have an increased risk of AMI. The AMI risk associated with gout was conditional on patients’ cardiovascular risk profile. Future work is needed to confirm these findings.

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High-Sensitivity C-Reactive Protein is a Predictor of In-Hospital Cardiac Events in Acute Myocardial Infarction Independently of GRACE Risk Score

Angiology ◽

10.1177/0003319711406502 ◽

2011 ◽

Vol 63 (1) ◽

pp. 30-34 ◽

Cited By ~ 13

Author(s):

Sergio Raposeiras-Roubín ◽

Cristina Barreiro Pardal ◽

Bruno Rodiño Janeiro ◽

Emad Abu-Assi ◽

José María García-Acuña ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Risk Score ◽

High Sensitivity ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Cardiac Events ◽

Hospital Outcomes ◽

Coronary Syndrome ◽

Grace Risk Score

High-sensitivity CRP (hsCRP) is being increasingly used as a marker for cardiac risk assessment and as a prognostic tool in acute coronary syndrome. We analyzed the relation between hsCRP values at admission and in-hospital outcomes in 98 consecutive patients with acute myocardial infarction (AMI) undergoing catheterization. Patients with cardiac events had more advanced Killip class, more proportion of depressed left ventricular ejection fraction (LVEF), higher Global Registry of Acute Coronary Events (GRACE) risk score, and higher hsCRP levels. High-sensitivity CRP and GRACE risk score showed a significant positive correlation ( r = .320, P = .002). In multivariate analysis, hsCRP resulted as a predictor of worse in-hospital outcomes independently of GRACE risk score (OR 1.122, CI95%:1.005-1.252, P = .040). The hsCRP value showing the maximum likelihood ratio for predicting cardiac events was 1.45 mg/dL. High levels of hsCRP were also associated with development of contrast-induced nephropathy but not with bleeding events.

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Abstract 16088: Comparison of Aspirin and Clopidogrel Therapy With Clopidogrel Alone Use Following Coronary Stent Implantation in Patients With Acute Myocardial Infarction

Circulation ◽

10.1161/circ.130.suppl_2.16088 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Jin Sup Park ◽

Kwang Soo Cha ◽

Donghun Shin ◽

Dae Sung Lee ◽

Hye Won Lee ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Stent Implantation ◽

Coronary Stent ◽

Coronary Stenting ◽

Observational Result ◽

Coronary Syndrome ◽

Coronary Stent Implantation ◽

Increased Risk ◽

One Year

Introduction: Dual antiplatelet (DAP) therapy with aspirin and a thienopyridine following coronary stenting is superior to aspirin alone use in reducing cardiovascular events in both acute coronary syndrome and stable angina. However, there is a doubt whether DAP therapy is more effective and safer than clopidogrel alone use in secondary prevention. Hypothesis: We assessed the hypothesis that we compared retrospectively clopidogrel alone use with DAP therapy in acute myocardial infarction (MI) patients treated with coronary stent. Methods: From the Korean MI registry, we selected a total of 13,348 patients who underwent coronary stent implantation and were discharged on clopidogrel alone use (n = 85, 0.6%) and DAP therapy (n = 13,263, 99.4%). Propensity score matching was used and two cohorts of 1:5 nearest neighbor matched patients were obtained to eliminate biased estimates. The primary endpoint was the composite of major adverse cardiac events (MACE; all-cause death, MI, or revascularization) at one-year. Results: In the two matched cohorts of clopidogrel alone use (n = 85) and DAP therapy (n = 425), there was no difference in all-cause death (3.1 vs. 3.5%, p = 0.82), cardiovascular death (2.1 vs. 2.4%, p = 0.892), MI (1.6 vs. 1.2%, p = 0.75), revascularization (6.6 vs. 8.2%, p = 0.583), and the composite of cumulative MACE (11.3 vs. 12.9%, p = 0.665) at median follow-up period of 11.8 months. Compared to DAP therapy, clopidogrel alone use was not associated with increased risk of all-cause death (hazard ratio [HR] 1.11, 95% confidence interval [CI] 0.314-3.93, p = 0.871), MI (HR 0.38, 95% CI 0.17-11.2, p = 0.763), revascularization (HR 0.808, 95% CI 0.353-1.851, p = 0.615), and the composite of MACE (HR 1.129, 95% CI 0.585-2.178, p = 0.717) at one-year. Conclusions: This observational study showed that clopidogrel alone use following coronary stenting was not associated with increased mortality and worse clinical outcomes at one-year compared to DAP therapy in patients with acute MI. Further studies are needed to support this observational result.

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Basic Clinical Characteristics and Hospital Outcomes of Acute Coronary Syndrome Patients-Sudan

Sudan Journal of Medical Sciences ◽

10.18502/sjms.v12i2.916 ◽

2017 ◽

Vol 12 (2) ◽

pp. 52

Author(s):

Taha AM ◽

Mirghani HO

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Clinical Characteristics ◽

P Value ◽

Case Report Form ◽

Percutaneous Coronary Angioplasty ◽

Hospital Outcomes ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment

Background: There are Variation in the presentation of the acute coronary syndrome between countries. The present study aimed to investigate the basic clinical characteristics and in-hospital outcomes among acute coronary syndrome patients in the Sudan.Material and Methods: A cross-sectional comparative study conducted among 202 consecutive acute coronary syndrome patients at a reference coronary care unit in Omdurman Teaching Hospital between July 2014 and August 2015. Participants signed a written informed consent, and then a case report form was filled. Information collected include vascular risk factors, vital signs, echocardiographic findings, and in Hospital complications. The local ethical committee approved the research, and the chi-square test was used to compare ST-segment Elevation (STSEACS) and None ST-Segment Elevation Acute coronary syndrome (NSTSEACS).Results: (out of 202 women (53.75%) in (NSEACS) P =0.009). Prior myocardial infarction, hypertension, diabetes mellitus, and, smoking were evident in 19.8%. 53.%, 30.2%, and 16.6% of acute coronary syndrome respectively, 97% of patients presented with chest pain, 54% presented to the hospital after 24 hours. Hypotension, heart failure, low ejection fraction, and in-hospital complications were more in (STSEACS) than (NSTSEACS), while (NSTEACS) patients received less Thrombolysis and Percutaneous coronary angioplasty P-value < 0.05Conclusions: Acute coronary syndrome patients were younger and had more complications than others in the West. ST-Segment Elevation Myocardial Infarction Patients are more likely to develop in-hospital complications and to receive reperfusion therapy. The limitation of the study is the lack of follow-up information after discharge.

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Pengaruh Healing Touch Terhadap Kecemasan Pada Pasien Infarak Miokard Di Rsud Syarifah Ambami Rato Ebu Bangakalan

NURSING UPDATE : Jurnal Ilmiah Ilmu Keperawatan P-ISSN : 2085-5931 e-ISSN : 2623-2871 ◽

10.36089/nu.v1i2.65 ◽

2019 ◽

Vol 1 (2) ◽

pp. 74-79

Author(s):

Mufarika M.Kep

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Sampling Technique ◽

P Value ◽

Test Results ◽

Healing Touch ◽

Risk Of Death ◽

Increased Risk ◽

Before And After ◽

Post Test

Acute myocardial infarction is a type of coronary heart disease that has a prevalence in Indonesia in 2013 of 0.5% or an estimated 883,447 people. Anxiety may be a risk factor for a poorer prognosis and an increased risk of death in patients with acute myocardial infarction. The results of preliminary study concluded that as many as 60% of respondents have a severe anxiety. The purpose of this study was to determine the effect of healing touch on anxiety in patients with Acute Myocardial Infarction at Syarifah Ambami Rato Ebu Bangkalan Hospital. The design of this study was pre-experimental and the design used one group pretest post test with anxiety variables on acute myocardial infarction and healing touch. The population of the study were 11 respondents and the samples taken were 11 respondents in Irna B Syarifah Ambami Rato Ebu Bangkalan Hospital. Sampling technique using purposive sampling. While the data collection tool using observation checklist sheet with test statistical test Wilcoxon Match Pairs Test. Result showed that there was a difference of decrease in anxiety before and after given healing touch. Wilcoxon Match Pairs Test results obtained results P Value 0,020, which means H0 rejected means there is influence of healing touch on anxiety in patients with Acute Myocardial Infarction in RSUD Syarifah Ambami Rato Ebu Bangkalan. From the results showed that healing touch can reduce anxiety in patients with Acute Myocardial Infarction so that researchers expect for other researchers to develop the number of samples become larger so that the results of the study can be more generalized.

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Treatment delay in STEMI is associated with heart failure and mortality. National data from the Norwegian myocardial infarction register

European Heart Journal ◽

10.1093/ehjci/ehaa946.1350 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K.K Halle ◽

R.E.S Govatsmark ◽

K.H Bonaa

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Time Delay ◽

Symptom Onset ◽

Missing Values ◽

Outcome Variable ◽

P Value ◽

Primary Pci ◽

Increased Risk

Abstract Background European guidelines in ST-segment elevation acute myocardial infarction (STEMI) recommends a primary PCI (P-PCI) strategy if wire crossing of the occluded artery can be performed within 120 min of ECG diagnosis. A large proportion of the Norwegian population lives in remote geographical areas where P-PCI may not be performed expeditiously. Time delay from first medical contact to primary PCI is expected to be related to outcomes like heart failure and mortality. Norwegian hospitals are by law required to register clinical data for all patients treated for acute myocardial infarction in the Norwegian Myocardial Infarction. The register includes >90% of eligible patients. Purpose The aim of the study was to investigate the association of time from first medical contact (FMC) to P-PCI with heart failure (EF <50%) and mortality. Methods The study includes all patients registered during 2015–2018 in the Norwegian Myocardial Infarction Registry with STEMI who were <85 years of age and had <12 hours from symptom onset to FMC. For patients with missing values, FMC was calculated as time of prehospital ECG minus 10 minutes. The primary outcome variable was heart failure (defined as ejection fraction <50% during hospitalization) or all-cause mortality within 1 year after hospitalization. We calculated ORs (95% CI) adjusted for age, gender, and history of myocardial infarction, hypertension, diabetes, and heart failure. Results During 2015–2018 a total of 6398 STEMI patients <85 years of age were registered in the Norwegian Myocardial Infarction Registry with less than 12 hours from symptom onset to FMC. Time delay from FMC to P-PCI were <90 minutes, 90–119 minutes, and >120 minutes in 40%, 25%, and 35% of the patients, respectively. Compared to patients with P-PCI within 90 minutes after FMC, the multivariable adjusted OR (95% CI; p-value) for heart failure or 1 year mortality was 1.05 (1.02–1.08; p<0.01) for patients with P-PCI within 90–119 minutes after FMC, and 1.05 (1.02–1.08; p<0.001) for patients with P-PCI >120 minutes after FMC. The corresponding ORs for 1 year mortality were 1.01 (0.99–1.02) and 1.03 (1.02–1.04), respectively, and the corresponding ORs for EF<50% were 1.07 (1.04–1.11) and 1.07 (1.04–1.11). Conclusion In Norway, only 40% of STEMI patients undergo P-PCI within 90 minutes after FMC, and 35% of patients undergoes P-PCI >120 minutes after FMC. Time delays of more than 90 minutes after FMC are associated with increased risk of heart failure and mortality. A fibrinolysis strategy may be preferred over P-PCI for a substantial proportion of STEMI patients. Funding Acknowledgement Type of funding source: None

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