Challenges in Timely Pharmacological Reperfusion Therapy of Acute ST-Elevation Myocardial Infarction Patients: A Cross-sectional Study
Introduction: Acute ST-Elevation Myocardial Infarction (STEMI) is the most severe presentation of an Acute Coronary Syndrome (ACS) resulting from sudden occlusion of one of the major epicardial coronary arteries resulting in myocardial injury and necrosis within minutes to few hours. Despite Pri...
Guardado en:
| Autores principales: | , , , |
|---|---|
| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
JCDR Research and Publications Private Limited
2021
|
| Materias: | |
| Acceso en línea: | https://doaj.org/article/2af9b5d761104163be9379ac15231936 |
| Etiquetas: |
Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
|
| Sumario: | Introduction: Acute ST-Elevation Myocardial Infarction (STEMI)
is the most severe presentation of an Acute Coronary Syndrome
(ACS) resulting from sudden occlusion of one of the major epicardial
coronary arteries resulting in myocardial injury and necrosis within
minutes to few hours. Despite Primary Percutaneous Coronary
Intervention (PPCI) being the gold standard, thrombolytic therapy
is still the most common form of reperfusion therapy in eligible
patients of acute STEMI even in large metropolitan cities in India.
Aim: To find the proportion of STEMI patients receiving thrombolytic
therapy within four hours of the onset of symptoms and within
30 minutes of reaching the hospital and to explore factors related to
Pain-To-Door (P2D) delay.
Materials and Methods: This was a single-centre cross-sectional
observational study of 147 STEMI patients conducted at a tertiary
care hospital in the National Capital Territory (India). from February
to May 2017. Ethical clearance was obtained from the Institute’s
Ethics Committee. All patients were interviewed and their medical
records reviewed. Factors related to delay in reaching hospital
and association of patient characteristics with those receiving
thrombolytic therapy were explored using univariable and
multivariable logistic regression.
Results: Mean age of the study population was 52.1±13.1 years
and 121 (82.3%) were men. Median P2D time was 4.7 hours (IQR2.2-17.0). Overall, 64 (43.5%) of 147 patients reached the hospital
within four hours of chest pain. Only 5 (3.4%) patients availed
ambulance to reach the hospital. Distance from the hospital,
seeking care elsewhere and delay in reaction to symptom were
reasons for the delay (>4 hours). Median Door-To-Needle (D2N)
time was 45.9 minutes (IQR- 30.6-61.2). Patients who reached
the hospital at night were more likely to be thrombolysed after
adjusting for time to reach the hospital.
Conclusion: Significant P2D and Door-To-Balloon (D2B) delays
still exist in large metro cities in India. Action is needed both at the
population level as well as system level to reduce these delays. |
|---|