Exploring the delay in the informed consent procedures of patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: Is it worth the wait?

Objective: To investigated the factors associated with informed consent delay in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) and the association between the delay and door-to-balloon time. Methods: : We conducted a nationally representative retrospective cohort study using patient data reported by hospital-based chest pain centers from 1 January 2016 to 31 December 2020. Results: : In total, 257,510 patients were enrolled in the analysis. Mean informed consent delay time was 22.4 minutes, accounting for 39.3% in door-to-balloon time. Older age (≥65 years) was significantly correlated with informed consent delay time (RR: 1.034, p=0.001). Compared with ethnic Han patients, the minority (RR: 1.146, p<0.001) had more likelihood to extend consent giving; compared with patients who were single, longer informed consent time was found in married patients (RR: 1.054, p=0.006). Patients with intermittent chest pain (RR: 1.034, p=0.011), and chest pain relief (RR: 1.085, p=0.005)were more likely to delay informed consent. As for transfer modes, EMS (RR: 1.063, p<0.001), transfer-in (RR: 1.820, p<0.001), and in-hospital onset (RR: 1.099, p=0.002) all had positive correlations with informed consent delay time compared to walk-in. Informed consent delay was significantly associated with prolonged door-to-balloon time (OR: 1.002, p<0.001). Conclusion: Informed consent delay provokes prolongation of emergency treatment delay, which potentially leads to poor outcome of STEMI patients. It is essential to shorten the delay time by identifying and intervening modifiable factors that are associated with shortening the informed consent procedure in China and other countries.