Prehospital Events in ST- Elevation Myocardial Infarction Undergoing Primary Angioplasty

• Main Authors: Sachin Dhungel, Rabi Malla, Chandramani Ahikari, Arun Maskey, Rajib Rajbhandari, Diwakar Sharma, Man Bhadhur KC, Binaya Rauniyar, Deepak Limbu, Milan Gautam, Ajay Adhikari, Hari chalise
• Format: Article
• Language: English
• Published: Nepal Medical Association 2017-12-01
• Series: Journal of Nepal Medical Association
• Subjects: cicardian pattern; prehosptial delay; Shahid gangalal hospital ;ST myocardial infarction
• Online Access: https://www.jnma.com.np/jnma/index.php/jnma/article/view/3386

Introduction: Pre-hospital delay includes time from onset of symptoms of myocardial infarction till arrival to emergency room of the hospital. This defines time from symptom onset to first medical contact and first medical contact to emergency room. This study aims to study the prehospital events and determining factors in patients undergoing primary angioplasty. Methods: This was a cross sectional study in Shahid Gangalal National Heart Centre for three months. Timings of chest pain, first medical contact time, transfer time to hospital and overall pre-hospital time for PCI and risk factors were analysed. Results: There were 79 cases with 66 (83.5%) males and 13 (16.5%) females with mean age 56±11.2 years. Risk factors were 60 (75.9%), smoking, 47 (59.5%) hypertension, 25 (31.6%) diabetes, 22 (27.8%) dyslipidaemia and 16 (20.3%) heart failure. Chest pain was   maximum in 5 to 9 AM. The median prehospital delay was 300 minutes (5.0 hours) of which symptom to first medical contact was 165 minutes and first medical contact to hospital was 80 minutes. The longer median prehospital delay for hypertension, diabetes, female and age ≥50 years and the shorter for male, age less than 50 years, dyslipidemia and heart failure, though not statistically significant. Private transport was the preferred from symptom to first medical contact and ambulance for first medical contact to emergency room. Patients received in ER had aspirin 72 (91.1%), atorvastatin 54 (68.4%) and double anti-platelets 45 (57%). Conclusions: Chest pain was common in morning and the prehospital delay can be minimized by improving time from symptom to first medical contact and first medical contact to Emergency room. Keywords:  cicardian pattern; prehospital delay; ST myocardial infarction.