In a previous quality control assessment of the management of STEMI in our centre–a tertiary centre in a rural area–we observed a decrease in intrahospital delays over time (2004→2013) from 98→39minutes (median) but unchanged extrahospital delays (203–220minutes).

To elucidate the determinants of these long extrahospital delays, 181 patients, undergoing PCI for STEMI (2013–2017) in our centre, were carefully interviewed. The first medical contact (FMC) allowed to assess 2 periods: onset of symptoms–FMC (period 1) and FMC–diagnosis (period 2). Results are given as mean values (median).

In 36%, the FMC took place via the general practitioner (GP). Period 1 was associated with the type of FMC (GP: 210±294, median=79min/EM call: 78±114, median=43min/direct hospital admission: 222±44, median=115min), the moment of symptoms onset (0–4 am: 198±192, median 142min/8–12 am: 96±126, median 60min), age (70–80 y: 262±324, median 120min/50–60 y: 198±438, median 63min) and the distance to our PCI centre expressed in minutes by car (<30′: 108±156, median=60min/>60′: 216±288, median=116min). Period 2 was depending on the type of FMC (GP: 234±600, median 56min/EM call: 31±29, median 22min/direct hospital admission: 25±55, median 10min).

In our local experience, FMC via the GP in case of STEMI is a major determinant for a longer extrahospital delay and should therefore be discouraged.