Analysis of Time Delay for Thrombolytic Therapy in ST - Elevation Myocardial Infarction

Suresh Kumar, P (2006) Analysis of Time Delay for Thrombolytic Therapy in ST - Elevation Myocardial Infarction. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Coronary Artery Disease(CAD) has been defined as impairment of heart function due to inadequate blood flow to heart. CAD has become an important epidemiological significant disease in developed as well as developing countries. There has been a large increase in incidence of cardiovascular disease in recent past in Indian subcontinent. A recent study by ICMR shows the prevalence rate has been found to be 80-120/1000. By the year 2015, It is predicted that CAD would replace the infectious disease as the major cause for mortality. An increase in mortality by 103% in males &about 90% in females from 1985-2015 is expected. Acute Myocardial Infarction results from prolonged Myocardial ischemia precipitated in most cases by occlusive thrombus at the site of preexisting Atherosclerotic plaque. A steady decline in the mortality rate from ST Elevation Myocardial infarction (STEMI) has been observed across several population group since1960. Several phases in management of patients have contributed to decline in mortality from STEMI. The “clinical observation phase” in first half of twentieth century focused on physical and laboratory finding where as treatment is bed rest and sedation. Subsequently “coronary care unit phase” in mid 1960 was noted for detailed analysis and vigorous management of cardiac arrhythmia. “The high technology phase” setting the stage of bed side haemodynamic monitoring. The “Modern reperfusion era” of coronary care was introduced by intracoronary and then intravenous fibrinolysis and development of PCI which revolutioned the management and declined the mortality of STEMI. Large clinical trials have definitively shown the value of thrombolysis in acute myocardial infarction. Thus attention shifted to increase the use of this therapy. Furthermore, there and other trails have shown that benefit of this therapy can be maximized with earlier treatment, that is benefit of thrombolytic therapy are greater in first hour after onset of symptoms. Important delay in administration of this treatment have been observed. These delay may reduce the efficacy of thrombolysis by increasing not only mortality but also morbidity. The Goal for the patient with STEMI should be to achieve a door to needle time with in 30 min and a door to balloon time within 90 min. The present study is to analyze the delay in thrombolytic therapy in myocardial infarction. AIM: 1. To determine the Prehospital and Door to needle time in thrombolytic therapy in ST-elevation Myocardial Infarction (STEMI). 2. To evaluate the influence of patient’s clinical characteristic in delay in thrombolytic therapy in ST-elevation Myocardial Infarction. MATERIALS AND METHODS: For the present investigation the sample includes 107 patients with STEMI consecutively admitted to intensive coronary care units in Stanley medical college during period of June 2004 to October 2004. Patients included in the study are the one who had a typical electrocardiogram changes including ST elevation greater than 0.1 mV in at least 2 contiguous precordial leads or at least 2 adjacent limb leads or new or presumably new LBBB. With a typical changes in the levels of serum enzyme with or without chest pain lasting > 30 minutes. Patients with symptoms of acute coronary syndrome with NSTEMI, unstable angina were excluded. Study Variables: On admission patient’s clinical profile, electrocardiographic data, information on administration of thrombolytic agents and complication if any were noted and investigation for cardiac enzymes and plasma sugar were taken and noted. During the hospital stay the patients were interviewed and completed a standard record form covering details of their past medical history. The time of onset of AMI symptoms was recorded as accurately as possible. For some patients (i.e., patients with cardiogenic shock, signs of dementia, etc.) This information was obtained from family members. The time of entry to hospital was recorded. The time of admission to the coronary care unit was recorded and so is the time of start of thrombolytic therapy .The pre-hospital time interval was defined as the time interval from the beginning of the most recent onset of chest pain or the latest episode of intensified or prolonged pain to entry to hospital. Study variables included: age, gender, alcohol consumption, cigarette smoking, hypertension, diabetes mellitus, history of coronary artery disease (documented history of angina and/or myocardial infarction), location of MI. CONCLUSION: The present study shows that in case of STEMI, the time interval between onset of symptoms and patient’s arrival is still far from optimal and Door to needle time is comparable with other countries. Diabetic patients present to hospital late and Door to needle time was higher for hypertensives. The other main factors contributing to prehospital delay are prior consultation with the local practitioner and unavailability of rapid transport facilities. The best way to minimize delay is probably by a public education campaign with a correctly designed message, (particularly Diabetics and Elderly persons should be explained about the symptoms of AMI) and to increase public awareness to use ambulance transport to hospital. The emergency department should constantly develop protocol and guidelines to assure rapid identification of AMI patients.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Time Delay ; Thrombolytic Therapy ; ST - Elevation ; Myocardial Infarction.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 04:00
Last Modified: 24 Mar 2018 04:40

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