Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A
Jahangir Rashid Beig1, Nisar A Tramboo1, Kuldeep Kumar2
1Dept. of Cardiology, SKIMS, Srinagar, aIndia.
Insights
Delays in ST-segment elevation myocardial infarction (STEMI) treatment, primarily prehospital, significantly impact patient outcomes. Addressing these delays is crucial for improving STEMI care.
Area of Science:
- Cardiology
- Public Health
- Emergency Medicine
Background:
- Delayed reperfusion in ST-segment elevation myocardial infarction (STEMI) is linked to adverse patient outcomes.
- Assessing treatment delays in STEMI patients within a specific state is critical for improving care.
Purpose of the Study:
- To evaluate the components and contributing factors of therapeutic delays in ST-segment elevation myocardial infarction (STEMI) patients.
- To identify determinants of delayed presentation and treatment in STEMI cases.
Main Methods:
- A study of consecutive STEMI patients admitted to tertiary care hospitals in Srinagar from 2012-2015.
- Analysis of various delay components: patient decision, referral, transportation, prehospital, and door-to-needle time.
- Identification of clinico-demographic factors associated with delayed STEMI treatment.
Main Results:
- Median treatment delay was 250 minutes, with prehospital delay comprising 83.8%.
- Patient decision accounted for 59% of prehospital delay; 39.8% of patients presented too late for thrombolysis.
- Rural residence, no prior coronary artery disease, and negative family history predicted delayed presentation. Misdiagnosis by local providers affected 44.7% of late presenters.
Conclusions:
- STEMI management in the region requires significant improvement to reduce treatment delays.
- Urgent interventions are needed to shorten both prehospital and in-hospital delays for STEMI patients.
Background:
Delayed reperfusion is associated with worse outcomes in ST-segment elevation myocardial infarction (STEMI). This study was conducted to assess the components and determinants of therapeutic delay in STEMI patients of our state.
Methods:
This study included consecutive patients of STEMI admitted to the coronary care units of two tertiary care hospitals in Srinagar, between 2012 and 2015. Various components of treatment delay including the patient's decision to delay, referral delay, transportation delay, prehospital delay, and door-to-needle time were calculated. Factors associated with delayed treatment and clinico-demographic correlates of late presentation were identified.
Results:
During a period of 3 years, 523 patients (mean age, 57.6 ± 10.5 years) were enrolled in this study. Thrombolysis was administered to 60.2% patients, while 39.8% of patients could not be thrombolysed because of late presentation. The median treatment delay was 250 minutes. Prehospital delay constituted about 83.8% of total treatment delay. Patient's decision to delay, referral delay, and transport delay constituted 59%, 16%, and 25% of prehospital delay, respectively. Median door-to-needle time was 40 minutes. Residence in rural areas [odds ratio (OR), 2.35; 95% confidence interval (CI), 1.60-3.46], absence of prior coronary artery disease (OR, 1.54; 95% CI, 1.00-2.39), and negative family history of coronary artery disease (OR; 2.76; 95% CI, 1.86-4.10), were identified as independent predictors of delayed presentation (p < 0.001). Interestingly, 44.7% of the patients presented late due to misdiagnosis by local healthcare providers.
Conclusion:
The standard of STEMI management in our state is far from ideal, and calls for a lot of improvement. Major efforts to reduce prehospital and in-hospital treatment delays are urgently needed.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
09:21Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:26Acute Coronary Syndrome V: Nursing Management
01:20Angina V: Nursing Management