Impact of limited English Proficiency on Ischaemic time and Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction

Background: Australian hospitals increasingly face the challenge of treating culturally and linguistically diverse (CALD) patients with limited English proficiency (LEP). We examined the impact of LEP on reperfusion times and outcomes in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Methods: Patients undergoing PCI for STEMI in 2013-2017, enrolled in the multi-centre Victorian Cardiac Outcomes Registry were included and linked to government administrative datasets to identify patients’ primary spoken language. The primary endpoint was 30-day major adverse cardiovascular events (MACE). Results: 568 (7.4%) of the 7,721 patients had LEP; they were more likely to be older, female, diabetic, and have severe renal impairment (all p < 0.02). Among primary PCI patients (n = 5,385), symptom-to-balloon time was longer for LEP patients (237 [IQR 158-429] vs. 195 [IQR 141-326] minutes, p < 0.001), driven by longer symptom-to-door times (STDT) (150 [IQR 90-276] vs. 114 [IQR 75-215] minutes, p < 0.001). LEP patients had higher 30-day MACE (11.8 vs. 9.1%, p = 0.04), severe left ventricular (LV) dysfunction (11.2% vs. 8.4%, p = 0.003) and heart failure readmissions within 30 days of PCI (5.2% vs. 2.0%, p < 0.001). On multivariate analysis, LEP was not an independent predictor of 30-day MACE (OR 1.27, 95% CI 0.82–1.95), but was an independent predictor of prolonged STDT>120 minutes (OR 1.24, 95% CI 1.02–1.52). Conclusion: LEP patients undergoing PCI for STEMI present later and are more likely to have severe LV dysfunction and heart failure readmissions, with higher short-term MACE. More effort to provide education in varied languages on early presentation in STEMI is required.