Mortality from ischemic heart disease and acute myocardial infarction in the City of Zagreb and Republic of Croatia 2001-2016

Ivanuša, Mario; Kralj, Verica; Olivari, Mario

doi:10.15836/ccar2019.184

Cited by 1 publication

(1 citation statement)

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“…Therefore, the survival benefit is governed by an entire chain of events starting from early recognition of symptoms to the prompt delivery of emergency services (EMS) and prompt transfer to a PPCI capable hospital [10,11]. Multiple studies, including the Zagreb study and Castiella et al, concluded that the biggest factor in pre-hospital delay was late recognition of symptoms and hence delay in seeking care, and this was independent of the effectiveness of the team or availability of the emergency services [12,13]. This observation was also shown in our study by the mean duration of chest pain being well over three hours.…”

Section: Discussionmentioning

confidence: 99%

Impact of Delayed Pain to Needle and Variable Door to Needle Time On In-Hospital Complications in Patients With ST-Elevation Myocardial Infarction Who Underwent Thrombolysis: A Single-Center Experience

Iqbal¹,

Jamal²,

Ahmed³

et al. 2022

Cureus

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BackgroundMyocardial infarction is a life-threatening event, and timely intervention is essential to improve patient outcomes and mortality. Previous studies have shown that the time to thrombolysis should be less than 30 minutes of the patient's arrival at the emergency room. Pain-to-needle time is a time from onset of chest pain to the initiation of thrombolysis, and door-to-needle time is a time between arrival to the emergency room to initiation of thrombolytic treatment. Ideally, the target for door-to-needle time should be less than 30 minutes; however, it is unclear if the door-to-needle time has a significant impact on patients presenting later than three hours from the onset of pain. As many of the previous studies were conducted in first-world countries, with established emergency medical services (EMS) systems and pre-hospital ST-elevation myocardial infarction (STEMI) triages and protocols, the data is not completely generalizable to developing countries. We, therefore, looked for the impact of the shorter and longer door-to-needle times on patient outcomes who presented to the emergency room (ER) with delayed pain-to-needle times (more than three hours of pain onset). ObjectiveTo determine the impact of delayed pain-to-needle time (PNT) with variable door-to-needle time (DNT) on in-hospital complications (post-infarct angina, heart failure, left ventricular dysfunction, and death) in patients with ST-elevation myocardial infarction (STEMI) who underwent thrombolysis. Methods and resultsA total of 300 STEMI patients who underwent thrombolysis within 12 hours of symptoms onset were included, which were divided into two groups based on PNT. These groups were further divided into subgroups based on DNT. The primary outcome was in-hospital complications between the two groups and between subgroups within each group. The pain-to-needle time was ≤3 hours in 73 (24.3%) patients and >3 hours in 227 (75.7%) patients. In-hospital complications were higher in group II with PNT >3 hours (p <0.05). On subgroup analysis, in-hospital complications were higher with longer door-to-needle time in group II (p<0.05); however, there was no difference in complications among group I. ConclusionOur study is consistent with the fact that shorter door-to-needle time, even in patients with delayed PNT (>3 hours), has a significant impact on in-hospital complications with no difference in mortality.

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Section: Discussionmentioning

confidence: 99%