Causes of in-hospital delay for door-to-needle times in patients presenting with acute ST-Elevation Myocardial Infarct in Rural Malaysia
Study Objective: Background: In developing countries such as Malaysia, the primary mode for revascularization is via thrombolytic therapy. The Malaysian Clinical Practice Guideline on acute ST-elevation myocardial infarction advised the implementation of a 30-minute door-to-needle time. This s...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Mosby Inc.
2008
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/3696/ http://irep.iium.edu.my/3696/ http://irep.iium.edu.my/3696/1/science_%283%29.pdf |
| Summary: | Study Objective: Background: In developing countries such as Malaysia, the
primary mode for revascularization is via thrombolytic therapy. The Malaysian
Clinical Practice Guideline on acute ST-elevation myocardial infarction advised the
implementation of a 30-minute door-to-needle time. This study aims to evaluate the
mean door-to-needle times and the reasons for in-hospital delays.
Methods: Ninety four patients with acute ST elevation myocardial infarction
patients were screened and 75 patients were recruited in this prospective observational
study. The mean door-to-needle times were recorded and the reasons for delays in
door-to-needle times were elucidated.
Results: The majority of patients were male (89.3%), of Malay ethnicity (84%),
presenting with anterior MI (69.3%) with a mean age of 57.0 � 9.52 years. The
mean door-to-needle time was 80.54 � 84.8 minutes. Only 20% achieved the 30-
minute door-to-needle time and only 65.3% achieved the 60 minute door-to-needle
time. The reasons for late thrombolysis were quoted as late referrals from A�E
(50%), hypertensive emergency (22%), resuscitation (17%) and others (11%).
Conclusion: There is significant in-hospital delay in administrating thrombolytic
agents for patients presenting with acute ST-elevation myocardial infarction. Some of
the delays were unavoidable (hypertensive emergency and hypotension or VT/VF requiring resuscitation) but the majority of the delay is due to late referrals from A�E
to attending cardiology on-call officers. |
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