{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T01:20:07Z","timestamp":1789867207073,"version":"4.0.1"},"reference-count":84,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>ST\u2010segment elevation myocardial infarction (STEMI) remains a major contributor to global cardiovascular morbidity and mortality, with outcomes varying considerably between high\u2010income and low\u2010 and middle\u2010income countries (LMICs). Although advances in reperfusion therapy and improvements in hospital\u2010based performance have decreased in\u2010hospital delays, pre\u2010hospital delay remains one of the largest components of total ischemic time, thereby restricting the survival benefit of timely reperfusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This narrative review synthesizes evidence on pre\u2010hospital delay in STEMI and interprets delay through a health\u2010system 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\u22122025). Evidence was interpreted using a conceptual framework comprising four pathways through which pre\u2010hospital delay is produced: recognition, decision\u2010making, access, and system readiness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across multiple observational studies and registry reports, median symptom onset\u2013to\u2013first medical contact intervals in high\u2010income countries are typically 60\u2013120\u2009min, supported by organized STEMI networks and higher EMS utilization, although inequities persist among vulnerable population. In several LMIC settings, symptom onset\u2013to\u2013FMC delays frequently exceed 300\u2009min and may extend beyond 480\u2009min, driven by limited EMS coverage and fragmented referral pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Overall, pre\u2010hospital 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\u2010communicable disease strategies may reduce avoidable STEMI mortality and narrow global inequities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.70352","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T12:06:26Z","timestamp":1779451586000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pre\u2010Hospital Delay in STEMI: A Narrative Review of Symptom Onset\u2013to\u2013First Medical Contact Across High\u2010Income and Low\u2010 and Middle\u2010Income Countries"],"prefix":"10.1002","volume":"49","author":[{"given":"Javeria","family":"Akhter","sequence":"first","affiliation":[{"name":"Indus Hospital and Health Network Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zain Ul","family":"Abedin","sequence":"additional","affiliation":[{"name":"King Edward Medical University Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huzafa","family":"Ali","sequence":"additional","affiliation":[{"name":"CMH Multan Institute of medical Sciences Multan Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Khan","sequence":"additional","affiliation":[{"name":"Peshawar Medical College Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Nasir","sequence":"additional","affiliation":[{"name":"Ivane Javakhishvili Tbilisi State University Tbilisi Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eeman","family":"Afroz","sequence":"additional","affiliation":[{"name":"Allama Iqbal Medical College Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0240-9835","authenticated-orcid":false,"given":"Muhammad","family":"Noshab","sequence":"additional","affiliation":[{"name":"International University of Kyrgyzstan Bishkek Kyrgyzstan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1311890"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/3402081"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.4244\/AIJ-D-21-00008"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcha.2022.101011"},{"issue":"1","key":"e_1_2_14_6_1","first-page":"29","article-title":"Pre\u2010Hospital Delay and Its Contributing Factors in Patients With ST\u2010Elevation Myocardial Infarction; 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