Late Assessment of Thrombolytic Efficacy (LATE) study with alteplase 6-24 hours after onset of acute myocardial infarction

doi:10.1016/0140-6736(93)91538-w

Cited by 344 publications

(3 citation statements)

References 19 publications

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“…Studies have shown that a major benefit is when patients are perfused within one hour of symptom onset [11,12]. While patients presenting later than 12 hours of symptom onset have no benefit or, in some cases, it exposes them to harm, especially in old-age patients [13,14].…”

Section: Discussionmentioning

confidence: 99%

Pre-hospital Delay and Its Reasons in Patients With Acute Myocardial Infarction Presenting to a Primary Percutaneous Coronary Intervention-Capable Center

Mujtaba

Sohail

Ram

et al. 2021

Cureus

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Objective This study aimed to assess the duration of pre-hospital delay among ST-Segment Elevation Myocardial Infarction (STEMI) patients and its contributing factors. Methodology A cross-sectional study was conducted at Rural Satellite Center in Larkana, Pakistan from May to September 2020. A total of 240 STEMI patients who underwent primary percutaneous coronary intervention (P-PCI) were included. The patients' demographic characteristics, index event characteristics, mode of transportation, misinterpretations, misdiagnoses, and financial problems were recorded. Data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Results The observed pre-hospital time was 120 minutes; 229 (median; interquartile range [IQR]). It was found that 33.3% of patients arrived within one hour of the symptom onset, while 20.4% of patients delayed hospital arrival for more than six hours. The delay rate was highest among patients aged 41 to 65 years. Moreover, delayed admissions were more common among females as compared to males (p=0.008). Among the causes of delay in hospital arrival were misinterpretation, misdiagnosis, and transportation and financial issues. Of these, misdiagnosis significantly influenced the delay rate, i.e., more than 50% of the misdiagnosed patients arrived hospital after six hours of symptom onset (p<0.05). Conclusion The P-PCI rural satellite center had a positive impact as the observed pre-hospital delay rate was considerably less as compared to that reported in the existing literature. Moreover, the confounding factors were misdiagnosis and misinterpretations. We need to develop the concept of immediate appropriate help-seeking among patients.

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Section: Discussionmentioning

confidence: 99%

Pre-hospital Delay and Its Reasons in Patients With Acute Myocardial Infarction Presenting to a Primary Percutaneous Coronary Intervention-Capable Center

Mujtaba

Sohail

Ram

et al. 2021

Cureus

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“…The emphasis on timely coronary reperfusion in the setting of ST-segment elevation Myocardial Infarction (STEMI) comes from older studies suggesting a significant reduction in mortality among patients treated with fibrinolytic therapy during the first hours after onset of symptoms and a progressive increase in fatal events in those presenting later [ 1 , 2 , 3 , 4 ]. In the LATE (Late Assessment of Thrombolytic Efficacy) study, the benefit of fibrinolytic treatment observed in patients presenting early after STEMI onset was not consistent in those enrolled between 12 and 24 h after the onset of chest pain [ 5 ]. Later, with the advent and wide usage of percutaneous coronary intervention (PCI) as the preferred method of reperfusion, the question of timing has become more relevant ([ 6 ], and international guidelines, based on previous studies on thrombolysis, meta-regression analyses, and in vivo series, recommended coronary revascularization within the first 12 h from symptoms onset [ 7 , 8 , 9 ].…”

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confidence: 99%

Late Presenters with ST-Elevation Myocardial Infarction: A Call to Action

Luca

Veneziano

Karaboue

2022

JCM

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“…Nowadays management of STEMI is based on early reperfusion to limit infarct size and improve patient outcome [6]. In trials based on thrombolytic therapy, the maximal bene t was delivered within the rst 2 hours of symptom onset [7] and no mortality bene t was seen in patients presenting beyond 12 hours [8]. In ST-elevation myocardial infarction (STEMI), timeframe is the single most important factor that affects mortality.…”

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confidence: 99%

Factors leading to delayed presentation among patients presenting with ST-elevation Myocardial Infarction in Emergency Department of a tertiary care hospital.

Zameer

Baig

Ahmed

et al. 2022

PBMJ

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The duration between the onset of myocardial infarction and first intervention plays a pivotal role in saving the life of the patients. Objective: To determine the frequency of various pre-hospital factors causing delay among patients presenting with STEMI in the emergency department of a teaching hospital. Methods: This is a descriptive observational study conducted at the Cardiology Department, Rawalpindi Institute of Cardiology (RIC), Rawalpindi from March to August 2019. A total of 142 patients presenting with ST-elevation myocardial infarction (STEMI) to the Emergency Department (ED) of RIC were enrolled. Electrocardiograms (ECGs) were reviewed for confirmation of STEMI and find the type of MI. Echo-cardiography was done to find out the ejection fraction (EF) of the left ventricle. Type of reperfusion therapy either thrombolytic therapy or primary percutaneous coronary intervention (PCI), time of symptom onset, and time of presentation in ED of RIC were noted. Patients were divided into four major groups depending upon the possible factors for delayed presentation: 1) Misinterpretation of symptoms, 2) Ignorance Of reporting urgently or waiting for symptoms to resolve, 3) Transportation problem and 4) First presentational facility where thrombolytic unavailable. Data were analyzed using the Statistical Package for Social Sciences (SPSS) v.23.0 (IBM, Armonk, U.S.). Results: The mean age was 53.2(SD=15.5). Out of 142 patients, most of them were males 130(91.5%). In our study, the majority 46.5% had a primary level of education. Transportation problems were the main reason for delayed presentation accounting for 45(34.5%), followed by misinterpretation of symptoms 40(28.2%), patients first presented at a facility where thrombolytic therapy was unavailable 27(19%) and patients were either ignorant of reporting urgently to a hospital or they waited for symptoms to resolve 26(18.3%). There was a significant difference in point of the first consultation, MI type, and time duration of delayed presentation among groups (P<.05). Conclusion: Transportation problems and misinterpretation of symptoms are the main reasons for the delay in getting reperfusion treatment for ST-elevation MI. Providing better primary care facilities available to rural areas as well as targeted awareness campaigns will greatly help in this regard.

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Late Assessment of Thrombolytic Efficacy (LATE) study with alteplase 6-24 hours after onset of acute myocardial infarction

Cited by 344 publications

References 19 publications

Pre-hospital Delay and Its Reasons in Patients With Acute Myocardial Infarction Presenting to a Primary Percutaneous Coronary Intervention-Capable Center

Pre-hospital Delay and Its Reasons in Patients With Acute Myocardial Infarction Presenting to a Primary Percutaneous Coronary Intervention-Capable Center

Late Presenters with ST-Elevation Myocardial Infarction: A Call to Action

Factors leading to delayed presentation among patients presenting with ST-elevation Myocardial Infarction in Emergency Department of a tertiary care hospital.

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