Factors Leading to Late Presentation of ST-Segment Elevation Myocardial Infarction for Thrombolytic Therapy

Authors

  • Muhammad Saleem Awan Ayub Medical College / Ayub Teaching Hospital, Abbottabad, Pakistan
  • Zia Ullah Khan Ayub Medical College / Ayub Teaching Hospital, Abbottabad, Pakistan
  • Matiullah Khan Ayub Medical College / Ayub Teaching Hospital, Abbottabad, Pakistan
  • Muhammad Furrakh Maqbool Sheikh Zayed Medical College, Rahim Yar Khan, Pakistan
  • Muhammad Abdul Rauf Kuwait Teaching Hospital/Peshawar Medical College, Peshawar, KP Pakistan
  • Shaista Jalil Health Department KP, Pakistan
  • Muhammad Yousuf Daud Ayub Medical College / Ayub Teaching Hospital, Abbottabad, Pakistan

DOI:

https://doi.org/10.52206/jsmc.2024.14.3.854

Abstract

Background: ST-segment Elevation Myocardial Infarction (STEMI) is a major cardiac emergency caused by total coronary artery obstruction, requiring immediate intervention to save myocardium and avoid sequelae. Streptokinase-assisted thrombolysis is still a practical and affordable option even as primary PCI develops. A number of reasons contribute to late presentation for thrombolysis, which highlights the need of removing obstacles to timely treatment in STEMI cases.
Objectives: The main purpose of this study was to identify factors that lead to late presentation of patients with STEMI.
Materials and Methods: This cross-sectional study was conducted for seven months between 15 June 2021 and 15 January 2022 in the Cardiology Department of Ayub Teaching Hospital, Abbottabad. A total of 142 patients who presented at least after 12 hours of their initial symptom of chest pain were included in the study using Non-probability purposive sampling technique.
Results: According to study results, the following reasons may contribute to a patient's delayed presentation after a STEMI: lack of symptom awareness (30.3%), absence of an initial ECG (19.7%), patient reluctance (23.3%), remote residence (9.8%), and misreading of the ECG (16.9%). For prompt STEMI management and better results, removing these obstacles is essential.
Conclusion: This study highlights the main factors that could lead to late hospital presentation of patients with STEMI for thrombolytic therapy. For prompt action and better results, it is imperative to address problems such misinterpreting ECG readings, delayed ECG assessment, patient resistance, and geographic barriers.
Keywords: Electrocardiogram (ECG), Non-ST elevation Myocardial Infarction (NSTEMI), ST-segment elevation Myocardial Infarction (STEMI), Streptokinase

References

Choudhury T, West NE, El-Omar M. ST elevation myocardial infarction. Clinical Medicine. 2016; 16(3):277-82. DOI: https://doi.org/10.7861/clinmedicine.16-3-277

Frampton J, Devries JT, Welch TD, Gersh BJ. Modern management of ST-segment elevation myocardial infarction. Current problems in cardiology. 2020;45(3):1003-93. DOI: https://doi.org/10.1016/j.cpcardiol.2018.08.005

Zeymer U, Ludman P, Danchin N, Kala P, Laroche C, Sadeghi M, et al. Reperfusion therapies and in-hospital outcomes for ST-elevation myocardial infarction in Europe: the ACVC-EAPCI EORP STEMI Registry of the European Society of Cardiology. European heart journal. 2021;42(44): 4536-49. DOI: https://doi.org/10.1093/eurheartj/ehab342

Vogel B, Claessen BE, Arnold SV, Chan D, Cohen DJ, Giannitsis E, et al. ST-segment elevation myocardial infarction. Nature reviews Disease primers. 2019;5(1):39. DOI: https://doi.org/10.1038/s41572-019-0090-3

Kumar SS, Sabu A. Fibrinolytic enzymes for thrombolytic therapy. Therapeutic enzymes: function and clinical implications. 2019:345-81. DOI: https://doi.org/10.1007/978-981-13-7709-9_15

Siriwattana K, Kuanprasert S, Wijarnpreecha W, Detnuntarat P, Chotayaporn T, Lertthanaphol K, et al. Accelerated Streptokinase versus Standard Dose Streptokinase in ST-Elevation Myocardial Infarction in Nakornping Hospital. Journal of the Medical Association of Thailand. 2020;103(2). DOI: http://www.jmatonline.com/index.php/jmat/article/view/10486

Chauhan V, Negi BD, Sharma G. Door-to-Needle time in myocardial infarction: small steps, huge dividends. Indian Heart Journal. 2019;71(2):143-5. DOI: https://doi.org/10.1016/j.ihj.2019.03.001

Ullah A, Hassan MU, Khan SB. Average time for presentation to the emergency and treatment with streptokinase in patients presenting to cardiac services in local dhq. Pakistan Heart Journal. 2018;51(3). DOI: https://doi.org/10.47144/phj.v51i3.1536

Bawaskar HS, Bawaskar PH, Bawaskar PH. Preintensive care: thrombolytic (streptokinase or tenecteplase) in ST elevated acute myocardial infarction at peripheral hospital. Journal of Family Medicine and Primary Care. 2019;8(1):62. DOI: https://doi.org/10.4103/jfmpc.jfmpc_297_18

Yang YQ, Pei YH, Situ QS, Du XZ, Chen XH, He AX. ECG criteria to distinguish hypertrophic cardiomyopathy featured with “Pseudo-STEMI” from acute ST-elevation myocardial infarction. Journal of Electrocardiology. 2023;77:10-6. DOI: https://doi.org/10.1016/j.jelectrocard.2022.11.009

Ghasemi R, Moghaddam SI, Ramezani F, Yaghubi M. The effect of the door to needle time of streptokinase administration on the left ventricular function and Thrombolysis in Myocardial Infarction (TIMI) flow grade in patients with anterior myocardial infarction: a single-center, prospective follow-up study. Acta Medica Iranica. 2022;60(4):229-34. DOI: https://doi.org/10.18502/acta.v60i3.9001

Ghasemi R, Moghaddam SI, Ramezani F, Yaghubi M. The effect of the door to needle time of streptokinase administration on the left ventricular function and Thrombolysis in Myocardial Infarction (TIMI) flow grade in patients with anterior myocardial infarction: a single-center, prospective follow-up study. Acta Medica Iranica. 2022;60(4):229-34. DOI: https://doi.org/10.18502/acta.v60i3.9001

Farshidi H, Rahimi S, Abdi A, Salehi S, Madani A. Factors associated with pre-hospital delay in patients with acute myocardial infarction. Iranian Red Crescent Medical Journal. 2013;15(4):312. DOI: https://doi.org/10.5812/ircmj.2367

Khaled MF, Adhikary DK, Islam MM, Alam MM, Rahman MW, Chowdhury MT et al. Factors responsible for prehospital delay in patients with acute coronary syndrome in Bangladesh. Medicina. 2022;58(9):120-6. DOI: https://doi.org/10.3390/medicina58091206

Ashraf S, Farooq U, Shahbaz A, Khalique F, Ashraf M, Akmal R et al. Factors responsible for worse outcomes in stemi patients with early vs delayed treatment presenting in a tertiary care center in a third world country. Current Problems in Cardiology. 2023:1020-49. DOI: https://doi.org/10.1016/j.cpcardiol.2023.102049

Ullah I, Ullah R, Ali Z, Ahmad I. Factors responsible for late presentation of patients with acute st elevation myocardial infarction. Journal of Postgraduate Medical Institute. 2020;34(2). DOI: https://jpmi.org.pk/index.php/jpmi/article/view/253

Hanifi N, Rezaee E, Rohani M. Time-to-treatment and its association with complications and mortality rate in patients with acute myocardial infarction: a prospective cohort study. Journal of Emergency Nursing. 2021;47(2):288-98. DOI: DOI: https://doi.org/10.1016/j.jen.2020.05.013

Venkatachelam R, Adilakshmi B, Ram Manohar T, Trivikrama Rao M, Abbaiah S. Factors affecting time to arrival in hospital among patients with acute myocardial infarction (MI). Journal of Scientific and Innovative Research. 2015;4(2):109-14. DOI: https://doi.org/10.31254/jsir.2015.4212

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. The Egyptian Heart Journal. 2013;65(2):51-5. DOI: https://doi.org/10.1016/j.ehj.2012.05.002

Mishra A, Prajapati J, Dubey G, Patel I, Mahla M, Bishnoi S, et al. Characteristics of ST-elevation myocardial infarction with failed thrombolysis. Asian Cardiovascular and Thoracic Annals. 2020;28(5):266-72. DOI: https://doi.org/10.1177/0218492320932074

Feng L, Li M, Xie W, Zhang A, Lei L, Li X, et al. Prehospital and in-hospital delays to care and associated factors in patients with STEMI: an observational study in 101 non-PCI hospitals in China. BMJ open. 2019;9(11):e031918. DOI: https://doi.org/10.1136/bmjopen-2019-031918

Additional Files

Published

24-07-2024

How to Cite

1.
Muhammad Saleem Awan, Zia Ullah Khan, Matiullah Khan, Muhammad Furrakh Maqbool, Muhammad Abdul Rauf, Shaista Jalil, Muhammad Yousuf Daud. Factors Leading to Late Presentation of ST-Segment Elevation Myocardial Infarction for Thrombolytic Therapy. J Saidu Med Coll Swat [Internet]. 2024 Jul. 24 [cited 2024 Dec. 5];14(3):249-53. Available from: https://jsmc.pk/index.php/jsmc/article/view/854