THROMBOLYSIS ON FIRST CONTACT SAVES MINUTES AND MYOCARDIUM

Abstract

Objective: To compare the door to needle time (DNT) for thrombolysis inacute myocardial infarction at the new chest pain clinic at emergencyroom with the old CCU at the Cardiology Department of Lady ReadingHospital, Peshawar.

Methodology: This was a retrospective study conducted at Lady ReadingHospital, Peshawar. Two data sets were acquired from hospital records.One for CCU at the cardiology department covering the span from 1 July,to 30 September, 2010. The other for the chest pain clinic emergencydepartment covered the span from 1 April to 15 May, 2017. All thepatients having ST elevated acute myocardial infarction eligible forthrombolytic therapy were included in the study. Door to needle time wascalculated in both the groups. Comparison of DNT between both groupswas made by using student t-test with p 0.05 taken as significant.Comparison between other base line qualitative characteristics was madeby using chi square test with p 0.05 taken as significant.

Result: Total of 140 patients were enrolled in CCU group with mean ageof 57.96±13.5 years. Out of these 60% were male. While 209 patientswere enrolled in ED group with mean age of 58.85±6.9 years. Of these65.1% were males. Mean DNT in CCU group was 72.42±50.85 minuteswhile in ED was 31.96±16.6 minutes with p=0.0001 with a reduction of41.30 minutes in the DNT. DNT of <30 minutes and between 30-60minutes was achieved in 7.1% and 62.8% in CCU group while in rest it wasmore than 60 minutes. In ED group the DNT achieved was <30 minutesin70.8% and 30-60 minutes in 29.2% of patients while none fell incategory of>60minutes.

Conclusion: The door to needle time for thrombolytic administration foracute myocardial infarction was significantly less at the chest pain clinicat emergency room than at the CCU at cardiology department.

Key Words: Thrombolysis, First contact, Myocardium Infarction, CCU