Clinical Review: Management of Patients with Acute ST-Elevation Myocardial Infarction
Fatema Ahmed Ali1, Hasan Altahoo1, Mary Lynch2
1Department of Medicine, College of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Kingdom of Bahrain.
Insights
This study evaluated acute ST-elevation myocardial infarction care, finding good guideline adherence. However, door-to-balloon times exceeded recommendations for out-of-hours procedures.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
Background:
- Acute ST-elevation myocardial infarction (STEMI) requires timely intervention.
- Adherence to established guidelines is crucial for optimal patient outcomes.
Purpose of the Study:
- To assess the quality of care for acute ST-elevation myocardial infarction (STEMI) patients.
- To identify areas for improvement in clinical practice within a cardiac center.
Main Methods:
- Retrospective, standards-based clinical review of 277 adult STEMI patients (2016-2017).
- Study aligned with National Institute for Health and Care Excellence guidelines and American Heart Association standards (door-to-balloon time ≤90 min).
- Data analyzed using Excel and SPSS; P < 0.05 considered significant.
Main Results:
- 72% of patients received primary percutaneous coronary intervention; median door-to-balloon time was 62 minutes.
- Door-to-balloon times exceeded 90 minutes significantly more often for out-of-hours presentations (P = 0.039).
- Transradial approach was utilized in 77.7% of cases.
Conclusions:
- Clinical practice demonstrated good compliance with established STEMI management guidelines.
- Door-to-balloon times for out-of-hours procedures require attention to meet recommended limits.
Aims:
The aim was to assess the quality of practice provided to acute ST-elevation myocardial infarction (STEMI) patients at the cardiac center, within a specified time frame and identify possible areas of improvement.
Settings And Design:
This is a retrospective standards-based clinical review, including adults diagnosed with acute STEMI between January 1, 2016 and January 1, 2017 of cases admitted and managed at the respective cardiac center.
Subjects And Methods:
The study was designed according to recommendations provided by the National Institute for Health and Care Excellence guidelines: "The acute management of myocardial infarction with ST-segment elevation;" alongside, the local standard: door-to-balloon time ≤90 min, adopted from the American Heart Association.
Statistical Analysis Used:
Data analysis was done through excel and SPSS for advanced statistical calculations. P < 0.05 was considered to be statically significant.
Results:
In total, 277 patients were included in the study. About 72% underwent primary percutaneous coronary intervention with 62 min as median door-to-balloon time. Door-to-balloon time >90 min was significantly higher when patients presented outside official hospital hours (P = 0.039). Transradial route was chosen in 77.7% of the cases.
Conclusions:
Practice at the cardiac center was found to show good compliance with the guidelines. However, door-to-balloon time for procedures performed out of official hospital working hours was slightly outside the recommended limit.
