VARIOUS DELAYS AND ITS DETERMINANTS IN THE TIMELINE OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION
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.