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Causes of in-hospital delay for door-to-needle times in patients presenting with acute ST-Elevation Myocardial Infarct in Rural Malaysia

Mohd Shah, Azarisman Shah and Ngow, Harris Abdullah and PA, Melor and Abdul Rani, Mohammed Fauzi and Ab Rahman, Jamalludin and Sapari, S. and K, Khairi and S, Noorfaizan and Maskon, Oteh (2008) Causes of in-hospital delay for door-to-needle times in patients presenting with acute ST-Elevation Myocardial Infarct in Rural Malaysia. Annals of Emergency Medicine, 51 (4). p. 530. ISSN 0196-0644

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Abstract

Study Objective: Background: In developing countries such as Malaysia, the primary mode for revascularization is via thrombolytic therapy. The Malaysian Clinical Practice Guideline on acute ST-elevation myocardial infarction advised the implementation of a 30-minute door-to-needle time. This study aims to evaluate the mean door-to-needle times and the reasons for in-hospital delays. Methods: Ninety four patients with acute ST elevation myocardial infarction patients were screened and 75 patients were recruited in this prospective observational study. The mean door-to-needle times were recorded and the reasons for delays in door-to-needle times were elucidated. Results: The majority of patients were male (89.3%), of Malay ethnicity (84%), presenting with anterior MI (69.3%) with a mean age of 57.0 � 9.52 years. The mean door-to-needle time was 80.54 � 84.8 minutes. Only 20% achieved the 30- minute door-to-needle time and only 65.3% achieved the 60 minute door-to-needle time. The reasons for late thrombolysis were quoted as late referrals from A�E (50%), hypertensive emergency (22%), resuscitation (17%) and others (11%). Conclusion: There is significant in-hospital delay in administrating thrombolytic agents for patients presenting with acute ST-elevation myocardial infarction. Some of the delays were unavoidable (hypertensive emergency and hypotension or VT/VF requiring resuscitation) but the majority of the delay is due to late referrals from A�E to attending cardiology on-call officers.

Item Type: Article (Journal)
Additional Information: 3808/3696
Subjects: R Medicine > R Medicine (General)
Kulliyyahs/Centres/Divisions/Institutes: Kulliyyah of Medicine > Department of Community Medicine (Effective: 1st January 2011)
Depositing User: Dr Jamalludin Ab Rahman
Date Deposited: 11 Apr 2013 04:02
Last Modified: 10 Mar 2016 04:02
URI: http://irep.iium.edu.my/id/eprint/3696

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