Thrombolytic use in the region around Amarillo, Texas, in patients with ST elevation myocardial infarction

Area of Science:

• Cardiology
• Emergency Medicine
• Health Services Research

Background:

• ST elevation myocardial infarction (STEMI) requires timely reperfusion therapy.
• Primary percutaneous coronary intervention (PCI) access is limited in some regions.
• Thrombolytic therapy is a critical alternative for STEMI patients lacking timely PCI.

Purpose of the Study:

• To evaluate the administration of thrombolytic therapy for STEMI patients in West Texas.
• To identify errors in thrombolytic therapy protocols in a region with poor primary PCI access.

Main Methods:

• Retrospective review of 79 STEMI patient medical records from 20 outlying facilities to two Amarillo, Texas hospitals in 2016.
• Evaluation of chest pain onset, ECG findings, medication reconciliation, and contraindications.
• Categorization of patients based on treatment appropriateness and identified errors.

Main Results:

• The most frequent error was the omission of appropriate accompanying medications (43%).
• Thrombolytic therapy was not given to eligible patients (21%) and inappropriately given to non-STEMI patients (4%).
• Only 13% of patients received appropriate thrombolytic therapy; 19% correctly did not receive it due to contraindications.

Conclusions:

• Significant deficiencies exist in the administration of thrombolytic therapy for STEMI in the studied West Texas region.
• Improving medication reconciliation and adherence to protocols is crucial for optimizing thrombolytic therapy outcomes.
• Addressing these care gaps is essential for improving STEMI patient management in underserved areas.