Exploring the Delay in the Informed Consent Procedures of Patients with ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Is It Worth the Wait?

Abstract Background Failure to achieve timely informed consent is the most important predictors of prolonged in-hospital delay in China. It is critically serious among patients with ST-elevation myocardial infarction (STEMI), which is the deadliest and most time-sensitive acute cardiac event. Informed consent procedure always begins on ambulance before door still does not complete yet after the catheterization laboratory is ready for percutaneous coronary intervention (PCI), which results in delayed treatment and poor clinical outcomes. This study aimed to investigate the factors associated with informed consent delay in patients with STEMI undergoing PCI, and its influence on in-hospital mortality. Methods We conducted a national-representative retrospective cohort study, drawing patient data reported by hospital-based chest pain centers, of admission between January 2016 and June 2019. Using generalized linear mixed models and negative binomial regression, we estimated factors independently predicting informed consent delay time. The associations of informed consent delay time, door-to-balloon (D2B) time and in-hospital mortality were analyzed by logistic regression, adjusted for patient characteristics. Results A total of 263,219 patients were enrolled in the analysis. Informed consent delay occurred in 44.7% (117,672) patients, of whom the median delayed time was 18.6 minutes (SD = 22.2). Patients with sustainable chest pain (RR: 1.032, p = 0.010), intermittent chest pain (RR: 1.083, p < 0.001), and dyspnea (RR: 1.096, p = 0.001) were more likely to delay informed consent. Among transfer modes, walk-in (RR: 1.165, p < 0.001), transfer-in (RR: 1.122, p < 0.001), in-hospital onset (RR: 1.248, p < 0.001) significantly correlated with extended informed consent delay time. The age of 35–64 years (RR: 0.941, p = 0.010) had a negative association with informed consent delay time. Informed consent delay was significantly associated with prolonged D2B time (OR: 1.148, p < 0.001), whereas there was no significant association between informed consent delay and in-hospital mortality. Conclusion Informed consent delay provokes prolongation of door-to-balloon time, which contributes to in-hospital delay that endangers STEMI patients. For better management of STEMI patients in emergent situations, it is essential to reduce the time of informed consent obtaining through effective patient-physician communication, and care coordination within and between hospitals. Trial registration: Retrospectively registered.