Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study
Background: Delayed reperfusion is associated with worse outcomes in ST-segment elevation myocardial infarction (STEMI). This study was conducted to assess the components and determinants of therapeutic delay in STEMI patients of our state. Methods: This study included consecutive patients of STEMI...
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| Format: | Article |
| Language: | English |
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Saudi Heart Association
2017-01-01
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| Series: | Journal of the Saudi Heart Association |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S101673151630121X |
| _version_ | 1818886198913925120 |
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| author | Jahangir Rashid Beig Nisar A. Tramboo Kuldeep Kumar Irfan Yaqoob Imran Hafeez Fayaz A. Rather Tariq R. Shah Hilal A. Rather |
| author_facet | Jahangir Rashid Beig Nisar A. Tramboo Kuldeep Kumar Irfan Yaqoob Imran Hafeez Fayaz A. Rather Tariq R. Shah Hilal A. Rather |
| author_sort | Jahangir Rashid Beig |
| collection | DOAJ |
| description | Background: Delayed reperfusion is associated with worse outcomes in ST-segment elevation myocardial infarction (STEMI). This study was conducted to assess the components and determinants of therapeutic delay in STEMI patients of our state.
Methods: This study included consecutive patients of STEMI admitted to the coronary care units of two tertiary care hospitals in Srinagar, between 2012 and 2015. Various components of treatment delay including the patient’s decision to delay, referral delay, transportation delay, prehospital delay, and door-to-needle time were calculated. Factors associated with delayed treatment and clinico-demographic correlates of late presentation were identified.
Results: During a period of 3 years, 523 patients (mean age, 57.6 ± 10.5 years) were enrolled in this study. Thrombolysis was administered to 60.2% patients, while 39.8% of patients could not be thrombolysed because of late presentation. The median treatment delay was 250 minutes. Prehospital delay constituted about 83.8% of total treatment delay. Patient’s decision to delay, referral delay, and transport delay constituted 59%, 16%, and 25% of prehospital delay, respectively. Median door-to-needle time was 40 minutes. Residence in rural areas [odds ratio (OR), 2.35; 95% confidence interval (CI), 1.60–3.46], absence of prior coronary artery disease (OR, 1.54; 95% CI, 1.00–2.39), and negative family history of coronary artery disease (OR; 2.76; 95% CI, 1.86–4.10), were identified as independent predictors of delayed presentation (p < 0.001). Interestingly, 44.7% of the patients presented late due to misdiagnosis by local healthcare providers.
Conclusion: 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. |
| first_indexed | 2024-12-19T16:17:32Z |
| format | Article |
| id | doaj.art-4ea41fa8c4c14b1cb08661bbd2d2a1d4 |
| institution | Directory Open Access Journal |
| issn | 1016-7315 |
| language | English |
| last_indexed | 2024-12-19T16:17:32Z |
| publishDate | 2017-01-01 |
| publisher | Saudi Heart Association |
| record_format | Article |
| series | Journal of the Saudi Heart Association |
| spelling | doaj.art-4ea41fa8c4c14b1cb08661bbd2d2a1d42022-12-21T20:14:35ZengSaudi Heart AssociationJournal of the Saudi Heart Association1016-73152017-01-0129171410.1016/j.jsha.2016.06.001Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based studyJahangir Rashid Beig0Nisar A. Tramboo1Kuldeep Kumar2Irfan Yaqoob3Imran Hafeez4Fayaz A. Rather5Tariq R. Shah6Hilal A. Rather7Dept. of Cardiology, SKIMS, Srinagar, aIndiaDept. of Cardiology, SKIMS, Srinagar, aIndiaDept. of Medicine, SKIMS, Srinagar, bIndiaDept. of Cardiology, SKIMS, Srinagar, aIndiaDept. of Cardiology, SKIMS, Srinagar, aIndiaDept. of Cardiology, SKIMS, Srinagar, aIndiaDept. of Cardiology, SKIMS, Srinagar, aIndiaDept. of Cardiology, SKIMS, Srinagar, aIndiaBackground: Delayed reperfusion is associated with worse outcomes in ST-segment elevation myocardial infarction (STEMI). This study was conducted to assess the components and determinants of therapeutic delay in STEMI patients of our state. Methods: This study included consecutive patients of STEMI admitted to the coronary care units of two tertiary care hospitals in Srinagar, between 2012 and 2015. Various components of treatment delay including the patient’s decision to delay, referral delay, transportation delay, prehospital delay, and door-to-needle time were calculated. Factors associated with delayed treatment and clinico-demographic correlates of late presentation were identified. Results: During a period of 3 years, 523 patients (mean age, 57.6 ± 10.5 years) were enrolled in this study. Thrombolysis was administered to 60.2% patients, while 39.8% of patients could not be thrombolysed because of late presentation. The median treatment delay was 250 minutes. Prehospital delay constituted about 83.8% of total treatment delay. Patient’s decision to delay, referral delay, and transport delay constituted 59%, 16%, and 25% of prehospital delay, respectively. Median door-to-needle time was 40 minutes. Residence in rural areas [odds ratio (OR), 2.35; 95% confidence interval (CI), 1.60–3.46], absence of prior coronary artery disease (OR, 1.54; 95% CI, 1.00–2.39), and negative family history of coronary artery disease (OR; 2.76; 95% CI, 1.86–4.10), were identified as independent predictors of delayed presentation (p < 0.001). Interestingly, 44.7% of the patients presented late due to misdiagnosis by local healthcare providers. Conclusion: 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.http://www.sciencedirect.com/science/article/pii/S101673151630121XCoronary artery diseaseLate presentationPrehospital delayST-elevation myocardial infarctionTreatment delay |
| spellingShingle | Jahangir Rashid Beig Nisar A. Tramboo Kuldeep Kumar Irfan Yaqoob Imran Hafeez Fayaz A. Rather Tariq R. Shah Hilal A. Rather Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study Journal of the Saudi Heart Association Coronary artery disease Late presentation Prehospital delay ST-elevation myocardial infarction Treatment delay |
| title | Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study |
| title_full | Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study |
| title_fullStr | Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study |
| title_full_unstemmed | Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study |
| title_short | Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study |
| title_sort | components and determinants of therapeutic delay in patients with acute st elevation myocardial infarction a tertiary care hospital based study |
| topic | Coronary artery disease Late presentation Prehospital delay ST-elevation myocardial infarction Treatment delay |
| url | http://www.sciencedirect.com/science/article/pii/S101673151630121X |
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