First medical contact-to-balloon time and in-hospital outcomes of primary percutaneous coronary intervention for ST-elevation myocardial infarction in Jenin, Palestine: a retrospective cohort study (2023-2024).

BACKGROUND: Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy for ST-elevation myocardial infarction (STEMI) when it can be delivered quickly. In Jenin governorate, most patients are first assessed at a single non-PCI governmental hospital before transfer to a PCI-capable center, and transfers may be slowed by movement restrictions, including Israeli checkpoints and road closures. We assessed adherence to the guideline first medical contact-to-balloon (FMC2B) target (≤ 120 min) and its association with in-hospital outcomes.

METHODS: We retrospectively included consecutive adults with confirmed STEMI who underwent PPCI after inter-hospital transfer from Jenin Government Hospital to Ibn Sina Hospital between 1 January 2023 and 31 December 2024. First medical contact (FMC) was defined as the first documented physician assessment time at the referring emergency department. Patients who self-presented directly to the PCI center or were treated outside the transfer-to-PPCI pathway were excluded. The primary outcome was FMC2B ≤ 120 min. Secondary outcomes were in-hospital major adverse cardiac events (MACE: death, reinfarction, or heart failure). Multivariable logistic regression was used to evaluate predictors of delayed reperfusion and MACE.

RESULTS: The final cohort included 202 patients (mean age 56.8 ± 11.2 years; 89.6% men). Median FMC2B was 124 min (IQR 91-166) and 47.5% (95% CI 40.7-54.4) achieved FMC2B ≤ 120 min. The largest component of delay was the FMC-to-PCI-center arrival interval (median 67 min, IQR 47-111). In-hospital MACE occurred in 15.8% (n = 32) and was higher when FMC2B was > 120 min than when it was ≤ 120 min (22.6% vs. 8.3%, p = 0.007). After adjustment, FMC2B > 120 min remained independently associated with MACE (OR 3.54, 95% CI 1.39-8.99).

CONCLUSIONS: In this transfer-dependent STEMI system, fewer than half of patients met the FMC2B ≤ 120-minute target, and delayed reperfusion was associated with worse in-hospital outcomes. Quality improvement should focus on faster diagnosis and transfer coordination, along with early cath-lab activation, to reduce system delays.