George Linsha, Ramamoorthy Lakshmi, Satheesh Santhosh, Saya Rama Prakasha, Subrahmanyam D K S
College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
J Emerg Trauma Shock. 2017 Apr-Jun;10(2):64-69. doi: 10.4103/0974-2700.201580.
Despite efforts aimed at reducing the prehospital delay and treatment delay, a considerable proportion of patients with ST elevation myocardial infarction (STEMI) present late and receive the reperfusion therapy after unacceptably long time periods. This study aimed at finding out the patients' decision delay, prehospital delay, door-to-electrocardiography (ECG), door-to-needle, and door-to-primary percutaneous coronary intervention (PCI) times and their determinants among STEMI patients.
A cross-sectional study conducted among 96 patients with STEMI admitted in a tertiary care center in South India. The data were collected using interview of the patients and review of records. The distribution of the data was assessed using Kolmogorov-Smirnov test, and the comparisons of the patients' decision delay, prehospital delay, and time to start reperfusion therapy with the different variables were done using Mann-Whitney U-test or Kruskal-Wallis test based on the number of groups.
The mean (standard deviation) and median (range) age of the participants were 55 (11) years and 57 (51) years, respectively. The median patients' decision delay, prehospital delay, door-to-ECG, door-to-needle, and door-to-primary PCI times were 75, 290, 12, 75, 110 min, respectively. Significant factors associated ( < 0.05) with patients' decision delay were alcoholism, symptom progression, and attempt at symptom relief measures at home. Prehospital delay was significantly associated ( < 0.05) with domicile, difficulty in arranging money, prior consultation at study center, place of symptom onset, symptom interpretation, and mode of transportation.
The prehospital delay time among the South Indian population is still unacceptably high. Public education, improving the systems of prehospital care, and measures to improve the patient flow and management in the emergency department are essentially required. The time taken to take ECG and to initiate reperfusion therapy in this study points to scope for improvement to meet the American Heart Association recommended timings.
尽管致力于减少院前延误和治疗延误，但仍有相当比例的ST段抬高型心肌梗死（STEMI）患者就诊延迟，在过长时间后才接受再灌注治疗。本研究旨在找出STEMI患者的决策延迟、院前延迟、门到心电图（ECG）、门到针以及门到直接经皮冠状动脉介入治疗（PCI）时间及其决定因素。
在印度南部一家三级医疗中心对96例STEMI患者进行了一项横断面研究。通过对患者的访谈和病历审查收集数据。使用Kolmogorov-Smirnov检验评估数据分布，并根据组数使用Mann-Whitney U检验或Kruskal-Wallis检验对患者的决策延迟、院前延迟以及开始再灌注治疗的时间与不同变量进行比较。
参与者的平均（标准差）年龄和中位数（范围）年龄分别为55（11）岁和57（51）岁。患者的决策延迟、院前延迟、门到ECG、门到针以及门到直接PCI时间的中位数分别为75、290、12、75、110分钟。与患者决策延迟相关（<0.05）的显著因素包括酗酒、症状进展以及在家中尝试采取症状缓解措施。院前延迟与住所、筹集资金困难、在研究中心预先咨询、症状发作地点、症状解读以及交通方式显著相关（<0.05）。
印度南部人群的院前延迟时间仍然高得令人无法接受。公众教育、改善院前护理系统以及改善急诊科患者流程和管理的措施至关重要。本研究中进行ECG和开始再灌注治疗所花费的时间表明仍有改进空间，以达到美国心脏协会推荐的时间标准。
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