For patients with acute ST-elevation myocardial infarction (STEMI), there is substantial site-level variability in achieving target treatment times and therefore a significant impact on clinical outcomes, new registry data analysis shows. The study, presented in a late-breaking clinical science session at Cardiovascular Research Technologies (CRT) 2025 on Saturday, set out to assess site level variability in achieving target first medical contact (FMC)-to-device time of ≤90 min for patients presenting initially to percutaneous coronary intervention (PCI)-capable hospitals and ≤120 min for those needing transfer — and assess whether these aspects are associated with clinical outcomes. “Hospitals strive to adhere to this goal in at least 75% of patients with STEMI based on the AHA and ACC recommendations,” said Yasser M. Sammour, MD, MSc, from the Houston Methodist DeBakey Heart and Vascular Center, Texas, during his presentation of the trial on Saturday. Study details Sammour and colleagues analyzed data from 73,826 patients with STEMI or STEMI-equivalent who underwent primary PCI within the American Heart Association (AHA) Get With The Guidelines Coronary Artery Disease (GWTG-CAD) registry between 2020 and 2022. Hospital performance was determined by the proportion of patients in whom target FMC-to-device time was met at each site for primary presentations and transfers, while treatment times and outcomes were compared according to performance and location urbanicity. “Of 60,109 patients who presented to PCI-capable hospitals, 59.5% achieved FMC-to-device time ≤90 minutes, and 50.3% out of 13,717 transfers had FMC-to-device time ≤120 minutes,” said Dr. Sammour. He highlighted ‘substantial’ institutional variability in achieving FMC-to-device time in both primary presentations (median 60.8%; interquartile range [IQR] 51.2%-68.8%) and transfers (median 50.0%; IQR 32.5%-66.9%). Patient presentation to a rural hospital did not affect the odds of meeting target FMC-to-device time for primary presentations (adjusted odds ratio [OR] 1.20; p=0.109), or transfers (adjOR 0.86; p=0.582) compared with urban centers, said Dr. Sammour. Furthermore, presentation to a high-volume vs low-volume center did not impact the odds of meeting target FMC-to-device for either primary presentations (adjOR 0.99; p=0.817) or transfers (adjOR 0.85; p=0.248). However, failure to achieve target FMC-to-device time was associated with increased risk of in-hospital mortality in both primary presentations (adjOR 2.21, 2.02-2.42; p=<0.001), and transfers (adjOR 2.44, 1.90-3.12; p=<0.001), said Dr. Sammour. Sites with low-performance in meeting FMC-to-device time in primary presentations were associated with increased risk of mortality compared with high-performance sites (adjOR 1.16; p=0.049). “Our contemporary analysis from the GWTG-CAD registry revealed substantial site-level variability in achieving target FMC-to-device times among patients with STEMI in the United States,” he concluded, noting that high-performing hospitals with shorter FMC-to-device times consistently met the recommended quality metrics. Image Credit: Bailey G. Salimes Image Caption: Yasser Sammour, MD, MSc, presents his late-breaking clinical science Saturday, March 8, 2025, at Cardiovascular Research Technologies (CRT).