Author + information
- Mahmut Özdemir1,
- Mustafa Yurtdaş2,
- Musa Şahin1,
- Nesim Aladağ2,
- Sevdegül Karadaş3,
- Naci Babat1 and
- Hasan Ali Gümrükçüoğlu1
We aimed to evaluate the admissional clinical status and the parameters which influences the selection of treatment options in patients with ST-segment elevation myocardial infarction (STEMI), and to detect the time intervals between the admission to the emergency and the start of medical intervention, and to compare the treatment methods.
Reperfusion strategies in a total of 165 patients with acute STEMI were retrospectively analyzed. Patients were classified into two groups: those directly admitted to our hospital and those referred to our hospital from another medical center. Door-to-balloon and door-to-needle times were measured. Efficiency of the treatment in patients treated with thrombolytic drugs was reported as successful or non-successful on the basis of reperfusion criteria. In patients treated with percutaneous coronary intervention, the success of intervention was defined as less than 50% angiographically residual stenosis with TIMI 3 antegrade flow.
Mean door-to-balloon time was 240 minutes for the referred group and 65 minutes for directly admitted group (p<0.001). The door-to-balloon time was achieved in 7% of patients according to American Heart Association (AHA) guideline and 26% of patients according to European Society of Cardiology (ESC). These rates were 86% for AHA guidelines and 97% for ESC guidelines in directly admitted group. Target door-to-balloon times, based on either AHA and ESC guidelines, were lower in the referred group than directly admitted group (p<0.001). Mean door-to-needle time was 41.3 minutes for referred group and 35 minutes for directly admitted group (p=0.454). Reperfusion success rate was 90.9% for primary coronary intervention and 84.6% for thrombolytic therapy (p=0.285).
The failure to achieve target door-to-balloon times in the referred group may be due to lack of an accurate pharmaceutical strategy. The possible reasons for this situation may be inadequate follow-up of guidelines, tendency of doctors to not assume enough responsibility and request of relatives of the patients to refer to our hospital. We think that transport and refer time also contribute to this issue. For this reason, we suggest that further and serious studies must be designed for determining more common use of thrombolytic therapy (for life) on admission.