Reperfusion Delays in Patients With ST-Segment Elevation Myocardial Infarction: A Prospective Observational Study From a Resource-Limited Setting

BackgroundTimely reperfusion is essential in the management of ST-segment elevation myocardial infarction (STEMI).Despite established treatment guidelines, delays in initiating reperfusion therapy remain a significant challenge, particularly in resource-limited healthcare settings. ObjectiveTo evaluate key time intervals in the STEMI reperfusion pathway, identify the principal stages associated with treatment delays, and quantify total ischemic time at a tertiary referral hospital in a resource-limited setting. MethodsWe conducted a prospective observational study involving 141 consecutive patients diagnosed with STEMI at Saturnino Lora Provincial Hospital in Santiago de Cuba, Cuba, from January 1, 2018, through January 1, 2019.Clinical characteristics, reperfusion strategies, and treatment intervals were evaluated.The total ischemic time was operationally defined as the interval from symptom onset to initial fibrinolytic administration or coronary guidewire crossing during primary percutaneous coronary intervention (PCI).Patients without reperfusion therapy or with incomplete treatment-timing documentation were excluded from this specific analysis. ResultsAmong 141 patients, 96 (68.1%) were male, and 113 (80.2%) were older than 55 years.First medical contact occurred within 60 minutes of symptom onset in 68 patients (48.2%), whereas 67 (47.5%) sought medical attention more than 120 minutes after symptom onset.A diagnostic electrocardiogram (ECG) was obtained within 10 minutes of first medical contact in 102 patients (72.3%).Of 108 patients who received fibrinolysis, 105 had complete treatment-timing documentation; among these, 65 (61.9%) received fibrinolytic therapy more than 30 minutes after the diagnostic ECG, with a median ECG-to-fibrinolysis interval of 60 minutes.Successful fibrinolysis was documented in 74 of 108 patients (68.5%).The median total ischemic time was 225 minutes among 120 evaluable patients.Among 60 patients who underwent PCI, the pooled median diagnostic ECG-to-PCI interval was 16.00 hours, with strategy-specific medians of 1.60 hours for primary PCI (n = 15), 12.75 hours for rescue PCI (n = 14), 18.61 hours for pharmacoinvasive PCI (n = 15), and 61.85 hours for ischemia-guided PCI (n = 16). ConclusionAlthough diagnostic ECG assessment was relatively timely in most patients, substantial delays persisted between STEMI diagnosis and initiation of fibrinolytic therapy.PCI timing varied considerably across reperfusion strategies, reflecting differences in clinical indications and treatment pathways.These findings identify opportunities to improve reperfusion timeliness through standardized treatment protocols, better coordination of STEMI care pathways, and routine monitoring of treatment intervals in resource-limited healthcare settings.