Door to reperfusion time in ST elevation myocardial infarction: four-year experience of an emergency department in Turkey

Abstract

Objectives: To calculate the door-to reperfusion time of ST Elevated Myocardial Infarction (STEMI) and to determine the factors which cause delay.
Materials and Methods: Charts of patients who were admitted to emergency department (ED) with STEMI between 2000 and 2004 were retrospectively evaluated. Door-to reperfusion time, reperfusion modality and factors that inşuenced the time and the modality of treatment were investigated. Patients were grouped as Percutaneous Coronary Intervention (PCI), intravenous thrombolytic treatment and medical treatment.
Results: The rate of reperfusion treatment was 91 of 135 (%67) patients. The rates of PCI and thrombolytic treatment were 52/91 (%57) and 39/91 (%43), respectively. Of 135 patients, 44 (%32) had medical treatment in the ED. After exclusion of three patients whose door-to reperfusion treatment time were not calculated, the mean door-to reperfusion treatment time for PCI in 49 patients was 35.4±28.6 min (range 10–155 min.), for thrombolytic treatment in 39 patients was 33.6±12.6 min. (range 15-70 min.). There was no statistical difference between the means of door-to reperfusion treatment time for PCI and thrombolytic treatment (p=0.692). The major factors which affected the door-to reperfusion time were (i) characteristics of chest discomfort (p<0.0001), (ii) door-to reperfusion treatment time >30 min. (p<0.0001) and (iii) admission to ED outside of business hours (p<0.0001). The characteristics of chest discomfort at admission and admissions to ED during overtime period also affected the choice of treatment modality (respectively, p=0.011 and p=0.003).
Conclusion: In our study, we found that the mean door-to reperfusion time is comparable for thrombolytic therapy and shorter for PCI when compared to international standards. Factors which inşuence delay are atypical chest discomfort and delay of door-to reperfusion treatment time more than 30 minutes. We cannot explain why admissions to ED outside of business hours inşuenced the choice of treatment modality.