Causes of in-hospital delay for door-to-needle times in patients presenting with acute ST-Elevation Myocardial Infarct in Rural Malaysia

• Main Authors: Mohd Shah, Azarisman Shah, Ngow, Harris Abdullah, PA, Melor, Abdul Rani, Mohammed Fauzi, Ab Rahman, Jamalludin, Sapari, S., K, Khairi, S, Noorfaizan, Maskon, Oteh
• Format: Article
• Language: English
• Published: Mosby Inc. 2008
• Subjects: R Medicine (General)
• Online Access: http://irep.iium.edu.my/3696/1/science_%283%29.pdf; http://irep.iium.edu.my/3696/; http://linkinghub.elsevier.com/retrieve/pii/S0196064408002461?showall=true

Study Objective: Background: In developing countries such as Malaysia, the primary mode for revascularization is via thrombolytic therapy. The Malaysian Clinical Practice Guideline on acute ST-elevation myocardial infarction advised the implementation of a 30-minute door-to-needle time. This study aims to evaluate the mean door-to-needle times and the reasons for in-hospital delays. Methods: Ninety four patients with acute ST elevation myocardial infarction patients were screened and 75 patients were recruited in this prospective observational study. The mean door-to-needle times were recorded and the reasons for delays in door-to-needle times were elucidated. Results: The majority of patients were male (89.3%), of Malay ethnicity (84%), presenting with anterior MI (69.3%) with a mean age of 57.0 � 9.52 years. The mean door-to-needle time was 80.54 � 84.8 minutes. Only 20% achieved the 30- minute door-to-needle time and only 65.3% achieved the 60 minute door-to-needle time. The reasons for late thrombolysis were quoted as late referrals from A�E (50%), hypertensive emergency (22%), resuscitation (17%) and others (11%). Conclusion: There is significant in-hospital delay in administrating thrombolytic agents for patients presenting with acute ST-elevation myocardial infarction. Some of the delays were unavoidable (hypertensive emergency and hypotension or VT/VF requiring resuscitation) but the majority of the delay is due to late referrals from A�E to attending cardiology on-call officers.