Outcomes according to timely or delayed primary percutaneous coronary intervention or fibrinolysis in a national registry of patients with ST-segment elevation myocardial infarction

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dc.contributor.authorLaffan, Jack
dc.contributor.authorGao, Huixuan
dc.contributor.authorStreet, Andrew
dc.contributor.authorCoughlan, J.J.
dc.contributor.authorArmstrong, Richard
dc.contributor.authorMaree, Andrew
dc.contributor.authorBlake, Gavin
dc.contributor.authorKearney, Peter
dc.contributor.authorCrowley, James
dc.contributor.authorKiernan, Thomas J.
dc.contributor.authorMcCreery, Charles
dc.contributor.authorAleong, Godfrey
dc.contributor.authorPeace, Aaron
dc.contributor.authorKennedy, Mark
dc.contributor.authorByrne, Robert A.
dc.date.accessioned2026-04-28T15:50:04Z
dc.date.available2026-04-28T15:50:04Z
dc.date.issued2026-03-31
dc.description.abstractBackground: Time to reperfusion is a predictor of long-term outcomes in ST-segment elevation myocardial infarction (STEMI). Timely primary percutaneous coronary intervention (PCI) is the preferred strategy recommended by guidelines. Fibrinolysis is recommended in patients in whom timely primary PCI is not feasible, though concerns persist about underutilisation of this approach. We examined long-term survival outcomes in STEMI patients according to treatment strategy received in a national STEMI registry in Ireland. Methods: This was an observational, nationwide, population-based study. We identified all STEMI cases from January 2013 to March 2018. After exclusion of patients with missing data, we divided patients into three groups as per reperfusion strategy—fibrinolysis, delayed primary PCI (>120 min of diagnosis) and timely primary PCI (<120 min of diagnosis)—and analysed mortality through to 3 years follow-up. A multivariate Cox proportional hazards model was used, with a propensity score matching analysis performed as a sensitivity analysis. Results: Of the 4156 patients included in this analysis, 202 (4.9%) were treated with fibrinolysis, 1075 (25.8%) were treated with delayed primary PCI and 2879 (69.3%) were treated with timely primary PCI. At follow-up, delayed primary PCI was associated with an increased risk of mortality through to 3 years in comparison to fibrinolysis (HR adjusted, 1.36; 95% CI 1.02 to 1.83, p=0.04). Timely primary PCI was associated with a comparable risk of mortality through to 3 years in comparison to fibrinolysis (HR adjusted, 1.10; 95% CI 0.81 to 1.49, p=0.53). Conclusions: A sizeable proportion of STEMI patients continue to receive treatment with delayed primary PCI. This is associated with an increased risk of mortality through 3 years in comparison to fibrinolysis.en
dc.description.versionPublished Version
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dc.format.mimetypeapplication/pdfen
dc.identifier.articleide003886
dc.identifier.authororcidLaffan, Jack
dc.identifier.authororcidGao, Huixuan
dc.identifier.authororcidStreet, Andrew
dc.identifier.authororcidCoughlan, J.J.
dc.identifier.authororcidArmstrong, Richard
dc.identifier.authororcidMaree, Andrew
dc.identifier.authororcidBlake, Gavin
dc.identifier.authororcidKearney, Peter
dc.identifier.authororcidCrowley, James
dc.identifier.authororcidKiernan, Thomas J.
dc.identifier.authororcidMcCreery, Charles
dc.identifier.authororcidAleong, Godfrey
dc.identifier.authororcidPeace, Aaron
dc.identifier.authororcidKennedy, Mark
dc.identifier.authororcidByrne, Robert A.
dc.identifier.citationLaffan, J, Gao, H, Street, A, Coughlan, J J, Armstrong, R, Maree, A, Blake, G, Kearney, P, Crowley, J, Kiernan, T J, McCreery, C, Aleong, G, Peace, A, Kennedy, M & Byrne, R A 2026, 'Outcomes according to timely or delayed primary percutaneous coronary intervention or fibrinolysis in a national registry of patients with ST-segment elevation myocardial infarction', Open Heart, vol. 13, no. 1, e003886, pp. 1-7. https://doi.org/10.1136/openhrt-2025-003886
dc.identifier.doi10.1136/openhrt-2025-003886
dc.identifier.endpage7
dc.identifier.issn2398-595X
dc.identifier.issued1
dc.identifier.journaltitleOpen Heart
dc.identifier.otherRIS: urn:4429FA287E9E54289B1FE0348AA969EF
dc.identifier.otherORCID: /0000-0001-6894-6044/work/225078160
dc.identifier.otherORCID: /0000-0001-9599-3540/work/225843164
dc.identifier.startpage1
dc.identifier.urihttps://hdl.handle.net/10468/18707
dc.identifier.volume13
dc.language.isoen
dc.publisherBMJ Publishing Group
dc.relation.urihttps://www.scopus.com/pages/publications/105036155781
dc.rightsPublisher Copyright: © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.
dc.rights.accessrightsopen access
dc.rights.licensenameAttribution-NonCommercial 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/
dc.statusPeer reviewed
dc.subjectAcute Coronary Syndrome
dc.subjectPrimary PCI
dc.subjectQuality of health care
dc.subjectSTEMI
dc.subjectThrombolysis
dc.subject[BEES]
dc.subjectTHROMBOLYSIS
dc.subjectPRIMARY PCI
dc.subjectQuality of Health Care
dc.titleOutcomes according to timely or delayed primary percutaneous coronary intervention or fibrinolysis in a national registry of patients with ST-segment elevation myocardial infarctionen
dc.typeArticle (peer-reviewed)
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