Impact of Treatment Delay on Mortality in ST-Segment Elevation Myocardial Infarction Patients with and Without Hemodynamic Instability

Abstract

Objective: To determine the frequency of mortality associated with delayed treatment time in ST-Segment Elevation Myocardial Infarction (STEMI) patients undergoing primary PCI, with and without hemodynamic instability.

Methodology: A descriptive cross sectional study was done at Department of Emergency Cardiology & Cath Lab, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan from June 2019 to December 2019. Patients between age of 30 to 70 years, both genders, presented with STEMI patients diagnosed undergoing primary PCI with treatment delay defined as the time > 90 minutes from admission to the hospital until the start of primary angioplasty were included. These patients were observed for 48 hours post PCI in ward to assess outcome in terms of mortality with respect to the hemodynamic instability. All the collected information was entered and analyzed using SPSS version 26.

Results: Overall mean of the patients was 55.2±9.5 years. Out of 153 patients, 105 (68.6%) were male while 48 (31.4%) were female. Positive family history was noted in 53 (34.6%) patients while 100 (65.4%) had no family history of heart disease. Mortality occurred in 10(6.5%) of the patients, which was higher among patients with unstable hemodynamics, old age (>50 years), males and smokers, while the findings were statistically insignificant (p>0.05). Likewise, diabetes, obesity, and family history showed no significant association with mortality (p>0.05).

Conclusion: Time to primary PCI is strongly associated with mortality risk with non-significant difference in stable versus unstable hemodynamic patients. Efforts to shorten door-to-balloon time should apply to all patients.