Impact of atypical presenting symptoms on door-to-balloon time and mortality outcomes in ST-segment elevation myocardial infarction.

Background: The impact of atypical symptom presentation in ST-segment elevation myocardial infarction (STEMI) on treatment timeliness and long-term outcomes remains insufficiently characterized. This study aimed to examine the association between symptom presentation and delays in door-to-balloon (DTB) time components and short- and long-term mortality, and to identify triage characteristics independently associated with atypical STEMI presentation.

Methods: We conducted a retrospective cohort study of STEMI patients undergoing primary percutaneous coronary intervention at a tertiary hospital in Taiwan between 2013 and 2022. Symptom presentation was classified as typical or atypical based on emergency department triage records. Primary outcomes included delays in DTB components and all-cause mortality at 30 days, 1 year, and 3 years. The secondary outcome was identification of triage characteristics associated with atypical presentation. Multivariable Cox and logistic regression models were used.

Results: Of 807 patients, 13.5% presented with atypical symptoms. Atypical presentation was independently associated with higher 30-day (aHR: 2.20, 95% CI: 1.15-4.21), 1-year (aHR: 1.91, 95% CI: 1.09-3.37), and 3-year (aHR: 1.73, 95% CI: 1.04-2.87) mortality. It was also linked to delays in door-to-ECG (aOR: 11.52, 95% CI: 6.04-22.06), activation-to-Cath lab-arrival (aOR: 1.71, 95% CI: 1.04-2.80), and Cath lab-arrival-to-balloon time (aOR: 1.95, 95% CI: 1.24-3.06). Older age, female sex, diabetes, cerebrovascular disease, tachycardia, and hypotension were independently associated with atypical presentation.

Conclusions: Atypical STEMI presentation is associated with treatment delays and increased short- and long-term mortality. Early identification of high-risk patients may improve timely care and clinical outcomes.

Clinical trial number: Not applicable.