Sultana Habib, Ahmed Noor, Ali Madni, Zaman K S.
Delays in Thrombolytic therapy among patients with ST-Elevation Myocardial Infarction presenting to a tertiary care hospital.
Pak J Cardiol Jan ;17(1):29-39.

This was an observational, analytic cross sectional study. It was conducted at NICVD Karachi in patients presenting with ST elevation myocardial infarction admitted to two general wards from June-August 2005.Patients were interviewed after an informed consent within first 72 hours of their admission to the ward. RESULTS: 192 patients were eligible to be included in the study, with mean age 54 years± 13 years. Most of the MI were anterior wall 121(63%)and rest were with inferior wall 71(37%). All of these patients were from low and middle socioeconomic group of society. 41.1% of patients had a total monthly income of below Rs5000. 52.6% of patients lived 20kms away from the hospital. Most of the patients experienced their symptoms about midnight to noon. 61 (32%) patients failed to receive thrombolytic therapy. Group who missed thrombolytic therapy all presented 6 hours after the start of chest pain while only 13 patients (9%) who presented 6 hours after the onset of chest pain received thrombolytic therapy. Pre-hospital delay time was significantly longer (median 24hrs versus 3 hours). Those who missed thrombolytic therapy had larger MI, and 67% of them had anterior wall MI. Delay time was not significant with respect to age, education, income, and high risk patients(were those with previous history of MI, angina CABG, had diabetes, hypertension, or had three major coronary risk factors). Delay time was decreased if patients experienced continuous chest pain (median 3.0 vs 9.0hrs), had knowledge about MI and thrombolytic (median 1.5 v s3.5 hrs), used ambulance service (median 2.25 vs 4.0hrs). Delay time was increased if patients were female (8.0 vs 3.0hrs), distance greater than 20km (median 13.2 vs 7.7hrs) experienced dysnoea, and heartburn, had intermittent chest pain, used public transport and getting consult before coming to hospital. (median 4.0 vs 1. 5hrs).

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