The timely treatment of STEMI varies substantially at the hospital level, for both primary presentation and transfers, and worse outcomes were observed in patients when the first medical contact (FMC)-to-device target was not met or who presented to low-performing hospitals, according to results from a large cross-sectional study published June 11 in JAMA Cardiology.

In this retrospective study, Yasser M. Sammour, MD, et al., examined site-level variability in achieving the quality metric of FMC-to-device time among 73,826 patients from 503 U.S. hospitals participating in the American Heart Association Get With the Guidelines-Coronary Artery Disease registry. Treated between 2020 and 2022, they were 62 years old on average and 28% were women.

Most (82%) patients presented directly to a PCI-capable center and the remainder required a transfer to a PCI-capable center.

Results showed that only 60% of patients presenting to a PCI-capable center were treated within the target FMC-to-device time of ≤90 minutes and only 50% of transferred patients achieved the target FMC-to-device time of ≤120 minutes.

In other findings, high-performing centers were more likely to meet all target treatment times than low-performing centers. Rural centers and urban centers had a similar rate of meeting the target FMC-to-device time, with an adjusted odds ratio (aOR) of 1.20 for primary presentations and 0.86 for transfers.

The risk of in-hospital mortality was higher when the FMC-to-device time was missed, with an aOR of 2.21 for primary presentations and 2.44 for transfers; comparing low vs. high performing hospitals the aOR was 1.16 for primary presentations.

The authors write that despite extensive evidence supporting timely STEMI treatment and established national standards, the results suggest that coordinated strategies are needed to enhance the adoption of these benchmarks with targeted local interventions to address system-based challenges.

In an accompanying editorial comment, Roxana Mehran, MD, FACC, writes that location and volume "were not associated with differences in performance or outcomes. These findings challenge assumptions about structural disadvantage and underscore that system preparedness, coordination, and process design – not geography – are key determinants of success."

Mehran also writes that results of the current analysis must "compel action... The next step must involve tailored solutions addressing barriers within each institution. Bridging the gap now requires renewed efforts and commitments to prioritize timely, coordinated STEMI care. Until then, the clock will continue to tick – against our patients."