ReviewClinical cardiology2026
Pre-Hospital Delay in STEMI: A Narrative Review of Symptom Onset-to-First Medical Contact Across High-Income and Low- and Middle-Income Countries.
Review in Clinical cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
0 citing papers in PubMed.
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Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimST-segment elevation myocardial infarction (STEMI) remains a major contributor to global cardiovascular morbidity and mortality, with outcomes varying considerably between high-income and low- and middle-income countries (LMICs). Although advances in reperfusion therapy and improvements in hospital-based performance have decreased in-hospital delays, pre-hospital delay remains one of the largest components of total ischemic time, thereby restricting the survival benefit of timely reperfusion.
methodsThis narrative review synthesizes evidence on pre-hospital delay in STEMI and interprets delay through a health-system performance and equity lens rather than viewing it only as an individual behavioral issue. Relevant studies were identified through a search of PubMed, Embase, and Scopus (2000-2025). Evidence was interpreted using a conceptual framework comprising four pathways through which pre-hospital delay is produced: recognition, decision-making, access, and system readiness.
resultsAcross multiple observational studies and registry reports, median symptom onset-to-first medical contact intervals in high-income countries are typically 60-120 min, supported by organized STEMI networks and higher EMS utilization, although inequities persist among vulnerable population. In several LMIC settings, symptom onset-to-FMC delays frequently exceed 300 min and may extend beyond 480 min, driven by limited EMS coverage and fragmented referral pathways.
conclusionOverall, pre-hospital delay in STEMI is a multidimensional and inequitable phenomenon suggesting the need for integrated approaches beyond awareness campaigns, including EMS strengthening, coordinated referral networks, early diagnostic capacity, financing protections, and governance and accountability mechanisms. Positioning emergency cardiac care within universal health coverage and national non-communicable disease strategies may reduce avoidable STEMI mortality and narrow global inequities.
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