FACTORS ASSOCIATED WITH DELAYING OF FIBRINOLYTIC THERAPY ADMINISTRATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Abstract

Objective: To evaluate the door-to-needle time for fibrinolytic therapy for acute myocardial infarction (AMI) and toidentify factors associated with a prolonged door-to-needle time.

Methodology: This cross-sectional study was conducted at Cardiology Department, Lady Reading Hospital, Peshawarbetween 1st July and 15th September 2010. All patients having AMI, eligible for thrombolysis were included in the study.The time of onset of chest pain and arrival in the hospital and any reason for delay was determined by asking thepatients, the relatives and/or the attending nurse.

Results: Out of 140 patients recruited, 60% (n=84) were males and mean age was 57.96 ± 13.55 years. The meandoor to needle time was 72.47± 50.85 minutes (range 25 – 305). Door to needle time of < 30 minutes was achieved in7.1% (10) patients, < 40 minutes in 21.4% (30) and < 50 minutes in 41.4% (58) patients. The main reason for delay instarting thrombolysis was logistic reasons in 42.9% (n=60) patients i.e. transfer from another hospital, non-availabilityof transfer staff from the casualty, unavailability of monitoring beds or non-availability of streptokinase in pharmacy.Other reasons were subtle ECG changes in 17.8% (n=25) cases, misinterpretation of symptoms in 21.5% (n=30),complete heart block needing pacemaker in 4.3% (n=6) , raised blood pressure in 4.3% (n=6) and arrival in oddtiming in 9.2% ( n=13) cases.

Conclusion: Door to needle time of < 30 minutes was achieved in only a small minority of our patients. The mainreason for delay was logistics.

Key words: Acute myocardial infarction, Door to needle time, Fibrinolytic therapy.