AzTrials
AzTrials

Myocardial Infarction (MI)PHHD-MINCT06738498

Impact of Pre-Hospital and Hospital Delays on Myocardial Infarction Outcomes

An observational study of Myocardial Infarction (MI), run by Al-Nahrain University at 1 site in Iraq.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

The goal of this prospective observational study is to investigate the impact of pre-hospital and hospital delays on the outcomes of myocardial infarction (MI) patients admitted to Al-Kadhimiya Teaching Hospital, Baghdad. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Myocardial Infarction (MI)
How many people
200 participants
Where
1 siteIraq
Study dates
20 Feb 2025to 20 Dec 2027
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: The study population will consist of adult patients aged 18 years and older who are diagnosed with acute myocardial infarction (MI), either STEMI or NSTEMI, confirmed by clinical symptoms, electrocardiogram (ECG), and elevated cardiac biomarkers (e.g., troponin). Participants will be admitted to Al-Kadhimiya Teaching Hospital within 12 hours of symptom onset and will undergo reperfusion therapy, such as thrombolysis or percutaneous coronary intervention (PCI).

Who may be able to join

  • Patients who provide informed consent (or a legal representative provides consent if the patient is unable to do so).
  • Patients who undergo reperfusion therapy, such as thrombolysis or percutaneous coronary intervention (PCI).
  • Patients admitted to Al-Kadhimiya Teaching Hospital within 12 hours of symptom onset.

Who cannot join

  • Patients with non-acute myocardial infarction (e.g., stable angina, prior MI).
  • Patients with severe comorbidities (e.g., advanced cancer, end-stage renal disease) that may complicate outcome assessments or interfere with treatment protocols.
  • Patients who are transferred to another facility before reperfusion therapy is initiated.
  • Pregnant women or breastfeeding women.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Iraq1 site, 1 recruiting
  • College of Medicine - Al-Nahrain University

    Baghdad

    Aws Al-Rubaye Lecturer, Internal Medicine, +9647730288897, awsalrubaye@nahrainuniv.edu.iq

    Abdulillah R. Khamees

    Recruiting

Other trials in Iraq

About this study

Official title: The Impact of Pre-Hospital and Hospital Delays on Myocardial Infarction Outcomes: A Prospective Study

The goal of this prospective observational study is to investigate the impact of pre-hospital and hospital delays on the outcomes of myocardial infarction (MI) patients admitted to Al-Kadhimiya Teaching Hospital, Baghdad.

The main questions it aims to answer are:

Read more

How do pre-hospital delays (e.g., patient transport and first medical contact) affect clinical outcomes such as mortality, complication rates, and recovery time in MI patients? What is the influence of hospital-related delays (e.g., time to intervention or reperfusion therapy) on the prognosis of MI patients?

Participants will:

Be monitored for the time elapsed from symptom onset to first medical contact and subsequent time intervals during hospital care.

Have their clinical outcomes, including in-hospital mortality, length of stay, and post-intervention complications, recorded and analyzed.

Read the detailed description

Myocardial infarction (MI) continues to be one of the leading causes of cardiovascular mortality globally, with outcomes highly dependent on the timeliness of treatment. Early reperfusion therapy is crucial for reducing mortality and minimizing long-term complications such as heart failure and arrhythmias. The impact of delayed treatment, both in the pre-hospital and hospital phases, is well documented, with longer delays significantly worsening clinical outcomes, particularly in terms of mortality and myocardial damage. Meanwhile, recent studies indicate that time delays to care among patients with STEMI (ST-segment elevation myocardial infarction) exist universally, showing a worse situation in low- and middle-income countries than in high-income countries.

Hospital and pre-hospital delays are critical determinants of MI outcomes. Factors contributing to pre-hospital delays include patient-related issues, such as lack of recognition of symptoms, misinterpretation of their severity, and delays in decision-making, as well as external factors like geographical barriers to healthcare facilities and limited access to emergency medical services. Based on these findings, some national or regional programs have been initiated to reduce the delays by targeting at controlling these factors through educational campaigns, implementation of prehospital ECG, establishing regional collaborative networks, and these actions have turned out to be effective.

Additional contributing factors are also evident, including administrative inefficiencies, delays in diagnosis, and challenges in accessing specialized care such as percutaneous coronary intervention or thrombolysis. Evidence suggests that prolonged hospital delays increase the risk of adverse clinical outcomes, including higher rates of mortality and heart failure.

Previous studies have highlighted the significant influence of time on patient recovery. Research has shown that early reperfusion therapy, such as thrombolysis or percutaneous coronary intervention, can significantly improve patient survival and reduce the risk of long-term complications. However, despite extensive global studies, there is limited research that focuses on the unique delays encountered in Middle Eastern and low-resource settings like Iraq. The healthcare challenges in these regions, including access to timely emergency services and hospital readiness, require further investigation to provide actionable insights.

In Iraq, particularly in Baghdad, the impact of pre-hospital and hospital delays on MI outcomes remains underexplored. While cardiovascular diseases, including MI, are prevalent, the healthcare system faces significant challenges, such as limited public awareness, inadequate pre-hospital care, and hospital system constraints. These factors may contribute to substantial delays in MI treatment, but their specific impact on patient outcomes has not been well studied. This research aims to fill this gap by conducting a prospective observational study at Al-Kadhimiya Teaching Hospital in Baghdad, assessing the extent of pre-hospital and hospital delays in the management of MI and their correlation with clinical outcomes. The study seeks to identify critical delays and propose recommendations for improving the timeliness of MI care in Iraq.

Keywords
Myocardial Infarction, Pre-Hospital Delay, Hospital Delay, Reperfusion Therapy, Patient Outcomes, Mortality, Time-to-Treatment, Cardiovascular Emergency
Medical subject headings
Myocardial Infarction

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. In-hospital Mortality

    percentage of patients who die during hospitalization following myocardial infarction.

    Measured: Up to discharge, an average of 7 days

Secondary outcomes (4)
  1. Time-to-Reperfusion Therapy

    The time (in minutes) from symptom onset to the initiation of reperfusion therapy (e.g., thrombolysis or percutaneous coronary intervention).

    Measured: Pre-Hospital Delay: Average of 4 hours from symptom onset to first medical contact. Hospital Delay: Average of 2 hours from hospital admission to the initiation of reperfusion therapy.

  2. Length of Hospital Stay

    The total duration of a patient's stay in the hospital, measured from the date of admission to the date of discharge.

    Measured: Up to discharge, an average of 7 days

  3. Major Adverse Cardiac Events (MACE)

    Includes recurrent myocardial infarction, heart failure, and arrhythmias occurring during hospitalization.

    Measured: Up to discharge, an average of 7 days

  4. Complication Rate

    The proportion of patients developing complications related to delays in treatment (e.g., cardiogenic shock, ventricular rupture).

    Measured: Up to discharge, an average of 7 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Dec 2024
  2. Study start20 Feb 2025
  3. Primary completion10 Dec 2027 (estimated)
  4. Study completion20 Dec 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06738498
Sponsor's protocol ID
UNCOMIRB20241213A
Other IDs
015
Acronym
PHHD-MI
Status last verified
Sep 2026
First submitted
13 Dec 2024
Last updated
17 Sep 2026
Results posted
No
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Shehab A, AlHabib KF, Bhagavathula AS, Hersi A, Alfaleh H, Alshamiri MQ, Ullah A, Sulaiman K, Almahmeed W, Al Suwaidi J, Alsheikh-Ali AA, Amin H, Al Jarallah M, Salam AM. Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries. Curr Vasc Pharmacol. 2019;17(4):388-395. doi: 10.2174/1570161116666180315104820.

    PubMed 29542414
  • Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997 May 24;349(9064):1498-504. doi: 10.1016/S0140-6736(96)07492-2.

    PubMed 9167458
  • GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1459-1544. doi: 10.1016/S0140-6736(16)31012-1.

    PubMed 27733281
  • Ladwig KH, Fang X, Wolf K, Hoschar S, Albarqouni L, Ronel J, Meinertz T, Spieler D, Laugwitz KL, Schunkert H. Comparison of Delay Times Between Symptom Onset of an Acute ST-elevation Myocardial Infarction and Hospital Arrival in Men and Women <65 Years Versus >/=65 Years of Age.: Findings From the Multicenter Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) Study. Am J Cardiol. 2017 Dec 15;120(12):2128-2134. doi: 10.1016/j.amjcard.2017.09.005. Epub 2017 Sep 18.

    PubMed 29122276
  • Peng YG, Feng JJ, Guo LF, Li N, Liu WH, Li GJ, Hao G, Zu XL. Factors associated with prehospital delay in patients with ST-segment elevation acute myocardial infarction in China. Am J Emerg Med. 2014 Apr;32(4):349-55. doi: 10.1016/j.ajem.2013.12.053. Epub 2014 Jan 3.

    PubMed 24512889
  • Naegeli B, Radovanovic D, Rickli H, Erne P, Seifert B, Duvoisin N, Pedrazzini G, Urban P, Bertel O. Impact of a nationwide public campaign on delays and outcome in Swiss patients with acute coronary syndrome. Eur J Cardiovasc Prev Rehabil. 2011 Apr;18(2):297-304. doi: 10.1177/1741826710389386. Epub 2011 Feb 11.

    PubMed 21450676
  • Park YH, Kang GH, Song BG, Chun WJ, Lee JH, Hwang SY, Oh JH, Park K, Kim YD. Factors related to prehospital time delay in acute ST-segment elevation myocardial infarction. J Korean Med Sci. 2012 Aug;27(8):864-9. doi: 10.3346/jkms.2012.27.8.864. Epub 2012 Jul 25.

    PubMed 22876051
  • Sullivan AL, Beshansky JR, Ruthazer R, Murman DH, Mader TJ, Selker HP. Factors associated with longer time to treatment for patients with suspected acute coronary syndromes: a cohort study. Circ Cardiovasc Qual Outcomes. 2014 Jan;7(1):86-94. doi: 10.1161/CIRCOUTCOMES.113.000396. Epub 2014 Jan 14.

    PubMed 24425697
  • Lee SH, Kim HK, Jeong MH, Lee JM, Gwon HC, Chae SC, Seong IW, Park JS, Chae JK, Hur SH, Cha KS, Kim HS, Seung KB, Rha SW, Ahn TH, Kim CJ, Hwang JY, Choi DJ, Yoon J, Joo SJ, Hwang KK, Kim DI, Oh SK; KAMIR Investigators. Pre-hospital delay and emergency medical services in acute myocardial infarction. Korean J Intern Med. 2020 Jan;35(1):119-132. doi: 10.3904/kjim.2019.123. Epub 2019 Nov 28.

    PubMed 31766823
  • George L, Ramamoorthy L, Satheesh S, Saya RP, Subrahmanyam DK. Prehospital delay and time to reperfusion therapy in ST elevation myocardial infarction. J Emerg Trauma Shock. 2017 Apr-Jun;10(2):64-69. doi: 10.4103/0974-2700.201580.

    PubMed 28367010
  • De Luca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 2004 Mar 16;109(10):1223-5. doi: 10.1161/01.CIR.0000121424.76486.20. Epub 2004 Mar 8.

    PubMed 15007008

Questions about this trial

What is this clinical trial studying?

An observational study of Myocardial Infarction (MI), run by Al-Nahrain University at 1 site in Iraq.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 17 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Iraq. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Abdulillah R. Khamees (+9647838571013, allaabed987@ced.nahrainuniv.edu.iq), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

In-hospital Mortality (time frame: Up to discharge, an average of 7 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06738498, which also lists 11 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Sep 2026.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in