Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study

Beig, Jahangir Rashid; Tramboo, Nisar A.; Kumar, Kapil; Yaqoob, Irfan; Hafeez, Imran; Rather, Fayaz Ahamad; Shah, Tariq R.; Rather, Hilal

doi:10.1016/j.jsha.2016.06.001

Cited by 34 publications

(36 citation statements)

References 27 publications

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“…Proper reperfusion is done by thrombolysis or primary PCI which can decrease the size of infract, protect the left ventricle and improve the longterm and short-term consequences of disease. 5,6 Doing primary PCI is the strategy of selective reperfusion in STEMI patients and when it is done urgently and in first hours of MI, it is effective in re-establishment of blood flow and this method is useful for patients with contraindication of fibrinolytic therapy. It seems that this method is more effective than fibrinolysis in bypassing clogged arteries and when it is done by experienced stuff and in specialized centers, it will be with long-term and short-term results.…”

Section: Introductionmentioning

confidence: 99%

The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome

Zamani

Abdollahi

Mardi

2018

Int J Basic Clin Pharmacol

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INTRODUCTIONCoronary artery disease (CAD) is the main cause of death, morbidity and disability in the world and their prevalence is highly increasing in developing countries. In CAD patients, acute coronary syndrome (ACS) has the most importance because of the high possibility of unpleasant cardiovascular events during follow-up was more in these patients. In 2008, 7.3 million (12.8%) out of 57 million deaths was because of myocardial infraction. In the United States, almost 650 thousand patients get new acute myocardial infraction (AMI) per year. The rate of early death (30 days) with AMI is about 30% and more than half of these cases occur before reaching to the hospital. 1,2During the last two decades, the rate of the death of coronary disease is decreasing in developed countries, whereas it is increasing in developing countries which is mostly because of long lifetime, urbanization and lifestyle changes. In the United States, the adjusted rate of death based age due to coronary disease has been declined to two third in four last decades which is the reflection of better diagnosis and reduce risk factors and also improvement of faster ABSTRACT Background: Primary PCI (PPCI) is the main reperfusion treatment for STsegment elevation myocardial infarction (STEMI). Anticoagulation therapy should be administered in patients undergoing PCI in order to limit the ischemic complications. In this study, we evaluated the effect of bolus unfractionated heparin (UFH) before PPCI on clinical outcome of patients with STEMI. Methods: In this randomized clinical trial, 196 patients (72.4% male with mean age of 63.02±13.37 years) with STEMI undergoing PPCI were randomly assigned to receive bolus UFH 60-90 U/kg in emergency room (case group) or during PCI (control group). Clinical outcomes, 30 day mortality, hematoma, left ventricle function improvement during follow-up were compared between groups. Results: In both groups there was good flow in the involved coronary artery after PCI. Case group compared to control group had significantly more cases with improved LVEF (28.1% vs. 9.7%, p=0.005). Also, case group compared to control group had more hematoma (3.1% vs. 0%, p=0.24) and higher mortality rate (6% vs. 4.2%, p=0.56) which had no significant difference between groups. Conclusions: PPCI in patients with STEMI accompanies with acceptable coronary flow irrespective of receiving bolus heparin. Receiving bolus heparin in these patients may have improved left ventricle function by increasing the rate of reflow. However, using bolus heparin did not accompany with increased rate of bleeding and had no effect on 30 day mortality rate.

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Section: Introductionmentioning

confidence: 99%

The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome

Zamani

Abdollahi

Mardi

2018

Int J Basic Clin Pharmacol

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“…More than fifty percentage of the patients age ranges from 45-65 yrs with mean of 60 yrs (SD=13.02) which is similar to the study by Perkins-Porras L. et al, [11] Beig JR. et al, [12] and Ribeiro S. et al, [13] where mean age was 59 (SD=11.2), 57.6 (SD=10.5), and 62 yrs (SD=13.64) respectively. Whereas, a study conducted in China reported the mean age of the patient was found to be 65.68 yrs (SD=12.68).…”

Section: Discussionmentioning

confidence: 99%

“…[19,20] However, few studies showed significantly lower door to needle time i.e 40 min and 34 min respectively. [12,21] The current study enlightened the most commonly used thrombolytic agent was tenecteplase (TNK) 54.7%. Nevertheless, the study conducted in Mexico confirmed streptokinase as a most commonly used lytic agents in 67% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…[11] In contrast to this, some studies have reported the presence of diabetes was associated with increased delay. [12,25] The major factors for pre-hospital delay were misinterpretation of symptoms (59%) and transportation delay (31%) due to difficult geographical location and non-availability of ambulance or other vehicles alike to the results from Mumbai with misinterpretation of symptoms (45%) and transportation problems (27%). [21] A study conducted in London figured out the decision time constituted 60% of the total pre-hospital delay period, home-to-hospital delay accounted for 40%.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with pre-hospital delay before reperfusion therapy in patients with ST-segment elevation myocardial infarction

et al. 2018

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Introduction: Cardiovascular disease remains the main cause of death in the world, and myocardial infarction represents the main contributor to this mortality. Timely restoration of myocardial blood flow with reperfusion therapy is crucial. Pre-hospital delay is a major obstacle for early reperfusion therapy and has negative impact on mortality and left ventricle function. Methods: A prospective study was carried in cardiology unit of a medical college from August 2013 to December 2017. Cases of acute ST segment elevation myocardial infarction that have undergone thrombolysis were recruited. Results: Out of 450 patients with ST Elevation Myocardial Infection (STEMI), delayed presentation was seen in 288 (64%) for >6 hrs and 108 (24%) patients for >12 hrs. The duration from onset of symptoms to the presentation in the emergency room (pre-hospital delay) was 12.66 hrs (SD=14.19, range = 30 min to 72 hrs). The door to needle time was 54 min (SD=24) The major factors for pre-hospital delay were misinterpretation of symptoms (59%) and transportation problems (31%). Conclusion: Misinterpretation of symptoms remain the most common cause of delayed presentation. Health education for public awareness can reduce the delay. Extension of thrombolytic therapy to district hospital and primary health center level after basic training for medical officer with checklist and collaboration in form of telemedicine with referral cardiac center may have major impact on morbidity and mortality reduction in acute STEMI patients with early reperfusion therapy.

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“…Visiting non-qualified or under-qualified medical practitioners or drug sellers or taking self-medication significantly increased pre-hospital delay. Such a trend is also present in India where visiting non-qualified practitioner was found to increase the delay (32). Though medical practice by non-qualified persons are rare in developed countries, consultation with non-medical personnel for advice or self-medication (33) and visiting GPs (19,24) markedly prolonged the prehospital delay there.…”

Section: Pre-hospital Delaymentioning

confidence: 93%

Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh

Rafi

Sayeed

Sultana

et al. 2020

Preprint

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Background: Delayed hospital presentation is a hindrance to the optimum clinical outcome of modern therapies of Myocardial infarction (MI). This study thus aims at finding the factors associated with prolonged pre-hospital delay and the impact of this delay on in hospital treatment outcome of MI patients of Northern Bangladesh.Methods: This cross sectional study was conducted in December 2019 in cardiology ward of a 1000 bed tertiary care hospital of Bangladesh. Socio demographic data, clinical features and patients' health seeking behavior was collected in a structured questionnaire from the patients diagnosed as STEMI or non-STEMI. Median with interquartile range (IQR) of pre hospital delay were calculated and compared between different groups. Patients were classified into two groups, those who admitted within 6 hours and those who admitted after 6 hours. Chi-square (χ²) test and multivariate logistic regression were used to estimate the determinants associated with delayed hospital admission. Effect of pre-hospital delay was determined using univariate and multivariate logistic regression.Results: 337 patients was enrolled in the study and their median (IQR) pre-hospital delay was 9.0 (13.0) hours. 39.5% patients admitted in the specialized hospital within 6 hours. In logistic regression, determinants of pre-hospital delay were patients age (for <40 years aOR 2.43, 95% CI 0.73-8.12; for 40 to 60 years aOR 0.44, 95% CI 0.21-0.93), family income (for lower income aOR 5.74, 95% CI 0.89-37.06; for middle income aOR 14.22, 95% CI 2.15-94.17), distance from primary care center £5 km (aOR 0.42, 95% CI 0.12-0.90), predominant chest pain (aOR 0.15, 95% CI 0.05-0.48), considering symptoms as non-significant (aOR 17.81,, referral from primary care center (for government hospital aOR 4.45, 95% CI 2. for private hospital OR 98.67, and not having family history of MI (aOR 2.65, 95% CI 1.24-5.71). Risk of in hospital death was almost 4 times higher who admitted after 6 hours in multivariate logistic regression (OR 4.64, 95% CI 1.87-11.50).Conclusion: Delayed hospital admission after onset of MI is more common in Bangladesh compared to developed countries. Appropriate measures should be taken by policy makers to improve this situation.

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Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study

Abstract: The standard of STEMI management in our state is far from ideal, and calls for a lot of improvement. Major efforts to reduce prehospital and in-hospital treatment delays are urgently needed.

Cited by 34 publications

References 27 publications

The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome

The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome

Factors associated with pre-hospital delay before reperfusion therapy in patients with ST-segment elevation myocardial infarction

Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh

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