Impact of age and comorbidities on treatment delays in acute coronary syndrome: a retrospective analysis

The increase in life expectancy is leading to a progressively aging population in Western countries. Approximately one-third of patients (pts) hospitalised for acute coronary syndrome are over 75 years of age, who are underrepresented in randomised controlled trials, and have ahigher mortality rate. The mortality in pts presenting with an acute coronary syndrome is associated with many factors such as the time delay to treatment. Hence, we aim to analyse delays in the emergent coronary referral pathway for our centre taking age in consideration.

Methods and Results: We conducted a retrospective analysis of 833 consecutive pts for primary percutaneous coronary angioplasty between January 2022 and April 2025. The median age was 64 ± 14 years, with 73% being male. Comorbidities included diabetes (27%), dyslipidemia (39%), hypertension (56%), smoking (48%), family history of cardiac disease (5%), and prior myocardial infarction (12%). The time variables analyzed included patient, ECG, diagnostic, transport and home delay, and procedure time. Additional variables were door-in-door-out, diagnosis-to-wire, first medical contact (FMC) to wire, and total ischemia time.

Pts over 75 years old were less frequently male (60% vs. 77%, p<0.001), had lower smoking history (14% vs. 58%, p<0.001), and family history of cardiac disease (1% vs. 6%, p=0.006). Conversely, they exhibited higher rates of diabetes (33% vs. 25%, p=0.030), dyslipidemia (48% vs 36%, p=0.003), and hypertension (70% vs 51%, p<0.001).

No significant differences were found regarding median patient (106 min vs. 101 min, p=0.069), transport (105 min vs. 86 min, p=0.263) or home delay (2 min vs. 2 min, p=0.269), diagnosis-to-wire time (150 min vs. 122 min, p=0.098), or procedure time (61 min vs. 57 min, p=0.183). However, older pts demonstrated significantly longer ECG (22 min vs. 14 min, p<0.001) and diagnostic delay (40 min vs. 22 min, p<0.001), door-in-door-out (150 min vs. 76 min, p<0.001), FMC to wire time (262 min vs. 174 min, p<0.001), and total ischemia time (466 min vs. 322 min, p<0.001).

After adjustment for cardiovascular risk factors, age over 75 years was identified as an independent predictor of prolonged ECG delay (p=0.018), door-in-door-out time (p=0.004), and FMC to wire time (p=0.001).

Conclusions: This study shows that our population is significantly delayed compared ESC guidelines gola, indicating that increased education and awareness are essential to reduce delays. Pts over 75, experienced longer delays in ECG, diagnostic and overall treatment times. Despite no difference in certain delays such as patient and transport times, factors like diabetes, dyslipidemia, and hypertension were more prevalent in this age group, further complicating timely care. Addressing these delays through targeted interventions focusing on older pts could help reduce treatment times, ultimately improving clinical outcomes for those affected by acute coronary syndrome.