Pre-hospital delay and mortality in different age groups with acute coronary syndrome: do we have enough evidence?

Introduction: Pre-hospital delay (p-HD) in acute coronary syndrome (ACS) influences the ability to perform percutaneous coronary intervention in a timely manner. Many factors, including age, have been identified to affect p-HD. An association between different age groups and p-HD in various ACS types is unclear. Moreover, data regarding the relationship between p-HD, age, and mortality are inconsistent.

Areas covered: In this review, we present current evidence of how p-HD influences mortality in various age groups and subtypes of ACS. Specific subgroups with knowledge gaps and future perspectives are identified.

Expert opinion: We identify specific subgroups of ACS where p-HD affects mortality in different age groups. First, p-HD may significantly affect the long-term prognosis of younger STEMI patients. Second, NSTEMI with known or presumed complex coronary lesions, often related to older age groups, might significantly benefit from p-HD reduction. Third, NSTEMI with ongoing myocardial infarction suffer from considerable p-HD, irrespective of age. These patients might benefit from reduced p-HD by improved education, public awareness, and increased medical service vigilance. Finally, incorporating artificial intelligence (AI) in pre-hospital care may provide further p-HD reduction.