FACTORS ASSOCIATED WITH DELAYING OF FIBRINOLYTIC THERAPY ADMINISTRATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective: To evaluate the door-to-needle time for fibrinolytic therapy for acute myocardial infarction (AMI) and to identify factors associated with a prolonged door-to-needle time.Methodology: This cross-sectional study was conducted at Cardiology Department, Lady Reading Hospital, Peshawar between 1st July and 15th September 2010. All patients having AMI, eligible for thrombolysis were included in the study.The time of onset of chest pain and arrival in the hospital and any reason for delay was determined by asking the patients, the relatives and/or the attending nurse.Results: Out of 140 patients recruited, 60% (n=84) were males and mean age was 57.96 ± 13.55 years. The mean door to needle time was 72.47± 50.85 minutes (range 25 – 305). Door to needle time of 30 minutes was achieved in 7.1% (10) patients, 40 minutes in 21.4% (30) and 50 minutes in 41.4% (58) patients. The main reason for delay in starting thrombolysis was logistic reasons in 42.9% (n=60) patients i.e. transfer from another hospital, non-availability of transfer staff from the casualty, unavailability of monitoring beds or non-availability of streptokinase in pharmacy.Other reasons were subtle ECG changes in 17.8% (n=25) cases, misinterpretation of symptoms in 21.5% (n=30),complete heart block needing pacemaker in 4.3% (n=6) , raised blood pressure in 4.3% (n=6) and arrival in odd timing in 9.2% ( n=13) cases.Conclusion: Door to needle time of 30 minutes was achieved in only a small minority of our patients. The main reason for delay was logistics.