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Published on: May 28, 2019
Prehospital Events in ST- Elevation Myocardial Infarction Undergoing Primary Angioplasty
Sachin Dhungel1, Rabi Malla2, Chandramani Adhikari2
1Department of Cardiology, College of Medical Science, Bharatpur, Chitwan, Nepal.
Insights
Pre-hospital delay in myocardial infarction patients undergoing primary angioplasty averaged 5 hours, with significant time lost between symptom onset and first medical contact. Improving these pre-hospital times is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Pre-hospital delay significantly impacts outcomes for patients with myocardial infarction (MI).
- Understanding pre-hospital events and their determinants is crucial for optimizing treatment pathways.
- Primary angioplasty is a time-sensitive intervention for acute MI.
Purpose of the Study:
- To investigate pre-hospital events and identify factors influencing delays in patients undergoing primary angioplasty.
- To analyze the duration of different phases of pre-hospital delay.
Main Methods:
- A cross-sectional study was conducted at Shahid Gangalal National Heart Centre.
- Data on chest pain onset, first medical contact, hospital transfer, and pre-hospital times were collected for patients undergoing PCI.
- Risk factors and transport methods were also analyzed.
Main Results:
- The median pre-hospital delay was 300 minutes (5.0 hours), with 165 minutes from symptom onset to first medical contact and 80 minutes from first medical contact to the emergency room.
- Smoking, hypertension, and diabetes were prevalent risk factors.
- Chest pain peaked between 5 AM and 9 AM. Private transport was common for initial contact, while ambulances were used for hospital transfer.
Conclusions:
- Pre-hospital delay in primary angioplasty patients is substantial, particularly in the time from symptom onset to first medical contact.
- Morning hours show a higher incidence of chest pain.
- Minimizing pre-hospital delay requires improvements in both symptom-to-first-contact and first-contact-to-emergency-room intervals.
Introduction:
Pre-hospital delay includes time from onset of symptoms of myocardial infarction till arrival to emergency room of the hospital. This defines time from symptom onset to first medical contact and first medical contact to emergency room. This study aims to study the prehospital events and determining factors in patients undergoing primary angioplasty.
Methods:
This was a cross sectional study in Shahid Gangalal National Heart Centre for three months. Timings of chest pain, first medical contact time, transfer time to hospital and overall pre-hospital time for PCI and risk factors were analysed.
Results:
There were 79 cases with 66 (83.5%) males and 13 (16.5%) females with mean age 56±11.2 years. Risk factors were 60 (75.9%), smoking, 47 (59.5%) hypertension, 25 (31.6%) diabetes, 22 (27.8%) dyslipidaemia and 16 (20.3%) heart failure. Chest pain was maximum in 5 to 9 AM. The median prehospital delay was 300 minutes (5.0 hours) of which symptom to first medical contact was 165 minutes and first medical contact to hospital was 80 minutes. The longer median prehospital delay for hypertension, diabetes, female and age ≥50 years and the shorter for male, age less than 50 years, dyslipidemia and heart failure, though not statistically significant. Private transport was the preferred from symptom to first medical contact and ambulance for first medical contact to emergency room. Patients received in ER had aspirin 72 (91.1%), atorvastatin 54 (68.4%) and double anti-platelets 45 (57%).
Conclusions:
Chest pain was common in morning and the prehospital delay can be minimized by improving time from symptom to first medical contact and first medical contact to Emergency room.
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