REASONS FOR DELAYED PRESENTATION OF PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION TO THROMBOLYTIC THERAPY IN CARDIOLOGY DEPARTMENT OF AYUB TEACHING HOSPITAL ABBOTTABAD

Authors

  • Ariz Samin Pak International Medical College, Peshawar Pakistan
  • Mehwish Taqueer Ayub Medical College, Abbottabad-Pakistan
  • Mahnoor Javaid Ayub Medical College, Abbottabad-Pakistan
  • Zoya Fayaz Ayub Medical College, Abbottabad-Pakistan
  • Noor ul Huda Ayub Medical College, Abbottabad-Pakistan
  • Nayha Nadeem Ayub Medical College, Abbottabad-Pakistan
  • Rida Fatima Saeed NUMS Pakistan
  • Ayesha Laraib Ayub Medical College, Abbottabad-Pakistan

Abstract

Background: ST elevation myocardial infarction (STEMI) is one of the leading causes of morbidity and mortality. Any delay in reperfusion therapy is associated with poor outcomes. This study was done to know the major reasons for delayed presentation to thrombolytic therapy. Methods: This cross-sectional study was conducted at the Coronary Care Unit (CCU) of Ayub Teaching Hospital, Abbottabad from March 2019 till June 2020. A total of 120 diagnosed STEMI patients late for thrombolysis therapy and admitted in the CCU were included in this study. Non-probability convenience sampling technique was used. Data was analysed using SPSS version 16.0. Results: The mean age of the patients was 61.6±1.07 years. Most of them were married (111), unemployed (85) and lived in urban areas (69). The most important reasons for delayed presentation of STEMI patients to thrombolytic therapy were due to the attribution of symptoms by patients to other conditions/diseases (57.5% CI:48.53-66.47), attempted self-treatment (50.8% CI: 41.76-59.91), misdiagnosis of symptoms (50%, CI:40.92-59.08), living in an area far away from any hospital (45%, CI:35.48-53.60) and problems of transportation (37%, CI:28.17-45.78). Conclusion: The early arrival of patients to health care facility in time is critical in diseases like STEMI. There can be many reasons for delayed presentation of patients to thrombolytic therapy but the most important ones were attribution of symptoms by patients to other diseases, attempted self-treatment, misdiagnosis of symptoms, and problems of transportation.

References

Chadwick Jayaraj J, Davatyan K, Subramanian SS, Priya J. Epidemiology of Myocardial Infarction. In: Pamukçu B, editor. Myocardial Infarction [Internet]. IntechOpen; 2019 [cited 2020 Sep]. Available from: https://www.intechopen.com/books/myocardial-infarction/epidemiology-of-myocardial-infarction

Vogel B, Claessen BE, Arnold SV, Chan D, Cohen DJ, Giannitsis E, et al. ST-segment elevation myocardial infarction. Nat Rev Dis Primers 2019;5(1):1–20.

Bueno H, Betriu A, Heras M, Alonso JJ, Cequier A, García EJ, et al. Primary angioplasty vs. fibrinolysis in very old patients with acute myocardial infarction: TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos) randomized trial and pooled analysis with previous studies. Eur Heart J 2011;32(1):51–60.

Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KA, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2003;24(1):28–66.

Gershlick AH, Banning AP, Myat A, Verheugt FW, Gersh BJ. Reperfusion therapy for STEMI: is there still a role for thrombolysis in the era of primary percutaneous coronary intervention? Lancet 2013;382(9892):624–32.

Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: Part 1: General considerations, the epidemiological transition, risk factors and impact of urbanization. Circulation 2001;104(22):2746–53.

Usman M. Door to Needle Time in Acute Myocardial Infarction Patients. J Rawal Med Coll 2017;21(2):127–30.

Terkelsen CJ, Sørensen JT, Maeng M, Jensen LO, Tilsted HH, Trautner S, et al. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. JAMA 2010;304(7):763–71.

Beig JR, Tramboo NA, Kumar K, Yaqoob I, Hafeez I, Rather FA, et al. Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study. J Saudi Heart Assoc 2017;29(1):7–14.

Taha R, Oraby M, Nasr G, El-Hawary A. Prevalence and causes of failure of receiving thrombolytic therapy in patients with acute ST-segment elevation myocardial infarction. Egypt Heart J 2013;65(2):51–5.

Ali J, Ahmad I, Faheem M, Irfan M, Gul AM, Hafizullah M. Factors associated with delaying of fibrinolytic therapy administration in patients with acute myocardial infarction. Khyber Med Univ J 2012;4(3):129–32.

Farshidi H, Rahimi S, Abdi A, Salehi S, Madani A. Factors associated with pre-hospital delay in patients with acute myocardial infarction. Iran Red Crescent Med J 2013;15(4):312–6.

Alishahi Tabriz A, Sohrabi MR, Kiapour N, Yazdani S. Factors Associated with Delay in Thrombolytic Therapy in Patients with ST-Elevation Myocardial Infarction. J Tehran Heart Cent 2012;7(2):65–71.

Callachan EL, Alsheikh-Ali AA, Wallis LA. Analysis of risk factors, presentation, and in-hospital events of very young patients presenting with ST-elevation myocardial infarction. J Saudi Heart Assoc 2017;29(4):270–5.

Juárez‐Herrera Ú, Jerjes‐Sánchez C. Risk Factors, Therapeutic Approaches, and In‐Hospital Outcomes in Mexicans with ST ‐Elevation Acute Myocardial Infarction: The RENASICA II Multicenter Registry. Clin Cardiol 2013;36(5):241–8.

Picariello C, Lazzeri C, Attanà P, Chiostri M, Gensini GF, Valente S. The impact of admission procalcitonin on prognosis in acute coronary syndromes: a pilot study. Biomarkers 2012;17(1):56–61.

Rodrigues JA, Melleu K, Schmidt MM, Gottschall CAM, Moraes MAP, Quadros AS. Independent predictors of late presentation in patients with st-segment elevation myocardial infarction. Arq Bras Cardiol 2018;111(4):587–93.

Das P, Ghafur S, Mollah A, Siddique S, Hossain A, Murshed A. Delayed Presentation of Patients with Acute Myocardial Infarction in Chittagong Medical College Hospital. Cadiovasc J 2016;9(1):3–8.

Taghaddosi M, Dianati M, Fath Gharib Bidgoli J, Bahonaran J. Delay and its related factors in seeking treatment in patients with acute myocardial infarction. ARYA Atheroscler 2010;6(1):35–41.

Meel R, Gonçalves R. Time to fibrinolytics for acute myocardial infarction: Reasons for delays at Steve Biko Academic Hospital, Pretoria, South Africa. S Afr Med J 2015;106(1):92–6.

Khan J. Factors Causing delayed presentation of patients with acute myocardial infarction to the hospital. Pak Armed Forces Med J 2011;61(4):511–5.

Mayor S. Acute MI is initially misdiagnosed in nearly a third of patients, study finds. BMJ 2016;354:i4713.

Khanam F, Shariful Islam M, Akter J, Lee WH. Factors Related to Delay in Seeking Medical Care Among Patients with Acute Myocardial Infarction in Dhaka. Jentashapir J Heal Res 2019;10(1):e92475.

Khraim FM, Carey MG. Predictors of pre-hospital delay among patients with acute myocardial infarction. Patient Educ Couns 2009;75(2):155–61.

Yunyun W, Tong L, Yingwu L, Bojiang L, Yu W, Xiaomin H, et al. Analysis of risk factors of ST-segment elevation myocardial infarction in young patients. BMC Cardiovasc Disord 2014;14(1):179–83.

Khan A, Phadke M, Lokhandwala YY, Nathani PJ. A study of prehospital delay patterns in acute myocardial infarction in an urban tertiary care institute in Mumbai. J Assoc Physicians India 2017;65(5):24–7.

Published

2021-11-08