Factors Responsible for Worse Outcomes in STEMI Patients With Early vs Delayed Treatment Presenting in a Tertiary
Sohaib Ashraf1, Usama Farooq1, Amir Shahbaz1
1Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.
Insights
Timely treatment for ST-segment elevation myocardial infarction (STEMI) significantly improves patient outcomes. Delayed treatment increases risks of heart failure, re-infarction, and mortality.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular event.
- Early intervention is crucial for improving STEMI patient outcomes.
Purpose of the Study:
- To compare outcomes between early and delayed treatment groups for STEMI patients.
- To identify factors contributing to treatment delays in STEMI cases.
Main Methods:
- Prospective comparative study of 186 STEMI patients.
- Patients divided into early (≤2 hours) and delayed (>2 hours) treatment groups.
- Data collected on demographic factors, delay causes, and STEMI outcomes.
Main Results:
- Delayed treatment (Group B) showed significantly higher rates of acute heart failure (9.7% vs 2.2%), re-infarction (18.3% vs 7.5%), sustained ventricular tachycardia (12.9%), ventricular fibrillation (14%), and in-hospital mortality (12.9%).
- Factors for delay included poor socioeconomic status, chronic stable angina history, and emergency room/ECG process delays.
- Nighttime pain and non-cardiac chest pain beliefs also contributed to delayed STEMI treatment.
Conclusions:
- Delayed STEMI treatment is associated with increased hospital stays and adverse outcomes.
- Prompt medical attention is vital for mitigating STEMI complications and improving survival rates.
Abstract:
The aim of the study is to compare the outcomes among ST-segment elevation myocardial infarction (STEMI) cases with early treatment vs delayed treatment. It was a prospective comparative study on 186 patients with consecutive (nonprobability) sampling. Two groups of cases were made as per their time to get admitted to the hospital (ie, within 2 hours of symptom onset = Group A; after 2 hours of symptom onset = Group B). Patients were asked for factors causing a delay in treatment after the onset of symptoms and were monitored for STEMI outcomes. The mean age of all patients was 46.62 ± 9.76 years and there were 140 (75.27%) male and 46 (24.73%) female, and male to female ratio 3:1.Factors significant for delayed treatment vs nondelayed treatment were poor social economic status (65.6% vs 20.4%), history of chronic stable angina (33.3% vs 11.8%), delayed response in the emergency room (20.4% vs 8.6%), delayed ECG acquisition (26.9% vs 8.6%), delayed ECG interpretation (25.8% vs 4.3%), pain at night 12:00-6:00 AM (21.5% vs 9.7%) and belief that the chest pain is noncardiac (26.9% vs 3.2%). Acute heart failure was significantly greater in group B (9.7%) in comparison with group A (2.2%), re-infarction was 18.3% in group B in comparison with 7.5% group A. Similarly sustained ventricular tachycardia and ventricular fibrillation and in-hospital mortality were higher in group B (12.9%, 14%, and 12.9% respectively). Due to delayed treatment patients had higher hospital stays, and complications, like acute heart failure, re-infarction, ventricular fibrillation, and in-hospital mortality.
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