Factors Influencing the Time to Fibrinolysis in ST-elevation Myocardial Infarction: A Retrospective Observational
Thejas Rao1, Ezhilkugan Ganessane2, Aashish S Raman1
1Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Introduction:
Timely reperfusion is critical for managing ST-elevation myocardial infarction (STEMI). We aimed to quantify treatment delays and identify factors associated with delayed fibrinolysis in STEMI patients.
Methods:
We conducted a retrospective observational study of 174 consecutive adult patients with STEMI who received fibrinolysis at a tertiary academic emergency department in Southern India between May 2023 and January 2024. Data were abstracted from medical records, and detailed prehospital information was obtained through structured telephone interviews. Multivariable logistic regression was used to identify independent predictors of late arrival (>6 h after symptom onset) and delayed door-to-needle (D2N) time (>30 min).
Results:
The median time from symptom onset to fibrinolysis was 320 min (interquartile range [IQR]: 210-480), driven primarily by a median prehospital delay of 300 min (IQR: 195-464). In contrast, the median D2N time was 15 min (IQR: 10-25), with 82.2% of patients achieving a D2N time of ≤30 min. Independent predictors of late arrival were lack of formal education (adjusted odds ratio [AOR]: 2.31; 95% confidence interval [CI]: 1.21-4.41) and unemployment (AOR: 1.98; 95% CI: 1.04-3.77). Independent predictors of delayed D2N time were a chief complaint other than chest pain (AOR: 8.98; 95% CI: 1.18-68.10), prior coronary artery disease (AOR: 4.86; 95% CI: 1.68-14.09), and consent time >5 min (AOR: 9.51; 95% CI: 2.65-34.16).
Conclusions:
Despite excellent inhospital performance metrics, the total ischemic time in STEMI patients remains high due to substantial prehospital delays associated with socioeconomic factors.
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