Factors Leading to Late Presentation of ST-Segment Elevation Myocardial Infarction for Thrombolytic Therapy
DOI:
https://doi.org/10.52206/jsmc.2024.14.3.854Abstract
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
How to Cite
Issue
Section
License
Copyright (c) 2024 The authors retain the copyrights. Authors are permitted and encouraged to post their work online (e.g. in institutional repositories or on their website), as it can lead to productive exchanges, as well as greater citation of published work.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.