Evaluation of Door to Needle Time and Predisposing Factor to it in A Tertiary Care Hospital, Chidambaram
Abstract
OBJECTIVE: The aim of our study is to evaluate the door to needle time for ST-segment elevation myocardial infarction and to identify factors associated with a prolonged door to needle time. STEMI most commonly occurs when thrombus formation results in complete occlusion of major epicardial coronary vessels. Percutaneous coronary intervention and Thrombolytics are the two choice of treatment available for STEMI. Where door to needle time have a significant role in determining the efficacy of thrombolytics.
METHODOLOGY: This is a prospective observational study conducted at RMMCH hospital, during the period of Nov 2014 to March 2015, all patient admitted with STEMI, who were thrombolysed were included in the study. Door to needle time is measured and reason for prolongation is identified. Patients who were diagnosed as NSTEMI or unstable angina and who were diagnosed as STEMI and not thrombolysed were excluded from the study.
RESULT: 100 patients were included in the study. Which comprises of 72 males and 28 females .door to needle time of < 30 minute was achieved in 27% of study population as per ACC/AHA guidelines were 73% failed to achieve. Highest number of population was observed in the age group of 61-70 which consist of 21 males and 6 females. Mean door to needle time was found to be 44 minutes. Majority of the patients were thrombolysed in between 31 – 45 minutes
CONCLUSION: less than a third of patients with STEMI received thrombolytics within the prescribed time interval of 30 minutes. Delay in decision making and lack of senior medical officers was found to be predisposing factor for the prolongation of door to needle time ,which requires special attention.Clinic.
References
2.Armstrong PW, Bogaty P, Buller CE, et al. The 2004 ACC/AHA guidelines: a perspective adaptation for Canada by the Canadian Cardiovascular Society Working Group. Can J Cardiol 2004;20:1075-1079.
3.DeBoer MJ, Hoorntje JC, Ottervanger JP, et al. Immediate coronary angioplasty versus intravenous streptokinase in acute myocardial infarction: left ventricular ejection fraction, hospital mortality and reinfarction. J Am CollCardiol 1994;23:1004-1008.
4.Stone GW, Grines CL, Browne KF, et al. Implications of recurrent ischemia after reperfusion therapy in acute myocardial infarction: a comparison of thrombolytic therapy and primary angioplasty. J Am CollCardiol 1995;26:66-72.
5.Weaver WD, Simes RJ, Betriu A, et al. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA 1997;278:2093-2098.
6.DeLemos JA, Braunwald E. ST segment resolution as a tool for assessing the efficacy of reperfusion therapy. J Am CollCardiol 2001;38:1283–94.
7.Rawles JM (GREAT Group). Quantification of the benefit of earlier thrombolytic therapy: Five-year results of the Grampian Region Early Anistreplase Trial (GREAT). J Am CollCardiol 1997;30:1181-1186.
8.O’Connor RE, Brady W, Brooks CS, et al. Acute coronary syndromes: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010;122:S787-S817.
9. Kuppuswamy VC, WebbeD , Gupta S, et al. Meeting the NSF targets for door-to-needle time in acute myocardial infarction – the role of a bolus thrombolytic. Br J Cardiol 2006;13:36-41.
10. Jehangir W, Daood MS, Khan M, et al. Evaluation of the door-to-needle time in patients undergoing fibrinolytic therapy after acute myocardial infarction. Pak J Physiol 2009;5(2):38-39.
