Time to Think Beyond Door to Balloon Time: Significance of Total Ischemic Time in Patients With St Elevation Myocardial Infarction

Khowaja, Sanam; Ahmed, Salik; Khan, Naveed Ullah; Saghir, Tahir; Nadeem, Syed Najaf; Qamar, Nadeem; Karim, Musa

doi:10.1016/s0735-1097(19)30835-6

Cited by 1 publication

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“…The primary purpose of STEMI management is the restoration of myocardium, hence, time to treatment determines the prognosis of STEMI patients. 9,[11][12][13][14][15] Therefore, in this study our aim was to assess the various delays in the timeline of STEMI and to understand the associated reasons for these delays. In this study of STEMI patients with either prehospital or post arrival delayed treatment, a significant number of patients had both pre-hospital and post arrival delay.…”

Section: Discussionmentioning

confidence: 99%

“…10 It is well established that the time of presentation of STEMI from the onset of chest pain and timely treatment determines prognosis of patient. [11][12][13][14][15] For a number of reasons the time between emergency room (ER) arrival and symptom onset was the primary concern among the cardiologists and efforts have made it possible to brought it down to less than 90 minutes of recommended cutoff in most of the situations. 10,16 However, up until recent years the scientific community was less attentive towards the pre-hospital delays.…”

Section: Introductionmentioning

confidence: 99%

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Various Delays and Its Determinants in the Timeline of St-Segment Elevation Myocardial Infarction

Khowaja¹,

Ahmed²,

Ashraf³

et al. 2021

Pak Heart J

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Objectives: To assess the various delays in the timeline of STEMI, its determinants, and impact on in-hospital outcomes. Methodology: In this study we included STEMI patients who were either presented late to ER or procedure was delayed. Pre-hospital delay was defied as chest pain (CP) to ER arrival time ≥120 minutes and hospital delay was defined as ER to procedure time ≥90 minutes. Reasons for pre-hospital and hospital delays and in-hospital complications and outcomes were recorded. Results: A total of 103 patients, 72.8%(75) male, with mean age of 54.75±11.8 years were enrolled. Median duration between CP and ER arrival 240[420-144.5] minutes with ≥120 minutes for 89.3%(92). Procedure was performed in 120[180-60] minutes of ER arrival with ≥90 minutes for 61.2% (63). Pre-hospital delay was caused by unawareness of symptoms (53.3%) followed by unavailability of transportation (29.3%), while, hospital delayed was caused by unavailability of resources (69.8%). Pre-hospital delay of ≥360 minutes was associated with higher rate of LV thrombus, 21.4% vs. 1.3%; p<0.001, and in-hospital re-current ischemia, 32.1% vs. 12%; p=0.017. Conclusions: In this study we observed that the most common causes of pre-hospital delay in our population are unawareness of symptomology and unavailability of transportation, while, the major cause of hospital delay was unavailability resources. Pre-hospital delay was associated with significantly higher rate of LV thrombus and in-hospital re-current ischemia.

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