Up to 1/3 of heart attacks present with ambiguous symptoms

Brieger D, Eagle KA, Goodman SG, et al; GRACE Investigators . Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high‐risk group: insights from the Global Registry of Acute Coronary Events. Chest. 2004;126:461–469.

1-year mortality increases by 7.5% for every 30-minute delay for time to treatment.

De Luca G, Suryapranata H, Ottervanger JP, et al. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 2004;109:1223-1225.

Percentage of hospitals in the US that are PCI capable: 21%

Herscovici DM, Boggs KM, Cash RE, et al. Development of a unified national database of primary percutaneous coronary intervention centers with co-located emergency departments, 2020. Am Heart J. 2022;254:149-155. doi:10.1016/j.ahj.2022.08.012

Less than 4% of transferred patients get treated within the recommended 90-minute time

Nallamothu BK, Bates ER, Herrin J, et al. Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation. 2005;111:761-767.

Estimated average symptom to door time 3-8 hours and door to balloon time in transferred patients ~3hr

Cannon CP, Gibson CM, Lambrew CT, et al. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA. 2000;283(22):2941-2947. doi:10.1001/jama.283.22.2941

Ottesen MM, Køber L, Jørgensen S, Torp-Pedersen C. Determinants of delay between symptoms and hospital admission in 5978 patients with acute myocardial infarction. The TRACE Study Group. Trandolapril Cardiac Evaluation. Eur Heart J. 1996;17(3):429-437. doi:10.1093/oxfordjournals.eurheartj.a014876