Various Delays and Its Determinants in the Timeline of ST-segment Elevation Myocardial Infarction | [Pakistan Heart Journal • 2021]

Author(s):

1. Sanam Khowaja: National Institute of Cardiovascular Diseases, Karachi, Pakistan

2. Salik Ahmed: National Institute of Cardiovascular Diseases, Karachi, Pakistan

3. Tariq Ashraf: National Institute of Cardiovascular Diseases, Karachi, Pakistan

4. Mahesh Kumar Batra: National Institute of Cardiovascular Diseases, Karachi, Pakistan

5. Saher Khowaja: Aga Khan University Hospital, Karachi, Pakistan

6. Mehak Nazir: Civil Hospital, Karachi, Pakistan

7. Muneeba Khan: National Institute of Cardiovascular Diseases, Karachi, Pakistan

8. Musa Karim: National Institute of Cardiovascular Diseases, Karachi, Pakistan

9. Kamran Ali Khowaja: Iqra University, Karachi, Pakistan

Abstract:

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 prehospital 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.

Page(s): 18-24

DOI: DOI not available

Published: Journal: Pakistan Heart Journal, Volume: 54, Issue: 1, Year: 2021

Keywords:

STsegment elevation myocardial infarction , prehospital delay , presentation delay , left ventricular thrombus

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