Delayed first medical contact to reperfusion time increases mortality in rural emergency medical services patients with ST-elevation myocardial infarction.

"CONFLICT OF INTEREST STATEMENT: The authors declare no conflicts of interest."

"FUNDING INFORMATION Dr. Stopyra received research funding from HRSA (H2ARH39976-01-00), Roche Diagnostics, Abbott Laboratories, Pathfast, Genetesis, Cytovale, Forest Devices, Vifor Pharma, and Chiesi Farmaceutici. Dr. Ashburn received funding from NHLBI (T32HL076132). Dr. Snavely received funding from Abbott Laboratories and HRSA (1H2ARH399760100). Dr. Miller received research funding from Siemens, Abbott Point of Care, Creavo Medical Technologies, Grifols, and NHLBI (5U01HL123027); he has a U.S. Patent on cardiac biomarkers for coronary artery disease related to cholesterol esters. Dr. Mahler received funding/support from Roche Diagnostics, Abbott Laboratories, OrthoQuidel Clinical Diagnostics, Siemens, Grifols, Pathfast, Genetesis, Cytovale, Beckman Coulter, and HRSA (1H2ARH399760100); he is a consultant for Roche, Quidel, Genetesis, Inflammatix, Radiometer, and Amgen and the Chief Medical Officer for Impathiq Inc. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award KL2TR001421. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health."

"We conducted a retrospective cohort study of STEMI patients cared for by eight rural North Carolina (NC) county EMS agencies from January 2016 to March 2020. Demographic, medical history, assessment, and time data were abstracted from each EMS agency electronic health record (EHR) and entered into a Research Electronic Data Capture (REDCap) database by study staff. These data were then linked to National Cardiovascular Data Registry (NCDR) data to create a 2016–2020 Rural NC Regional STEMI Data Registry. This study was approved by the Wake Forest University Institutional Review Board and granted a waiver of informed consent. The STROBE guidelines helped direct the research and article development processes. A data registry flow diagram is presented in . This study was registered at ClinicalTrials.gov (NCT04381260)."