Care time Delays in Acute Coronary Syndromes with Persistent St Elevation (stem) and the Delaying Factors: Prospective STUDY About 50 Cases in the Cardiology Department of Aristide le Dante Hospital.

Abstract

The care of acute coronary syndrome with persistent ST-elevation (STEMI) is a time-trial race: ‘‘time is myocardium”. The treatment relies on myocardial reperfusion by percutaneous coronary intervention (PCI) or fibrinolysis as promptly as possible. The main objective of this work was to assess the care time delays and the delaying factors during STEMI. We conducted a prospective, descriptive and analytic study over a 6 months’ time period. Were included all the patients received for STEMI. We have studied the care time delays and the delaying factors. We have compiled 50 patients. The mean age was 58.4 years and the sex-ratio M/F 2.5. The chest pain was typical in 39 patients. The mean time elapsed between the beginning of the pain and the first medical contact was 12 h 16 min. Transport (76%) and self-medication (70%) were the significant delaying factors found (p = 0.0001). The mean time elapsed between the first medical contact and the electrocardiogram was 9 h 57 min. The main factors delaying the diagnosis were the unavailability of the electrocardiogram device and the absence of electrocardiogram prescription (p = 0.001). The mean time elapsed between the electrocardiogram and the admission in the cardiology department was 3 h 02 min. The transport was the principal factor lengthening that time delay (p = 0.0001). Among the patients admitted directly in cardiology department, the mean time delay to perform the ECG was 30 min. The mean time delay of fibrinolysis was 2 h 11 min. Streptokinase shortage was the most frequent delaying factor (p = 0.001). The mean time delay between the qualifying ECG and the PCI completion was 2 h 42 min. The unavailability of the medical team was the first factor lengthening that time delay (p = 0.0001). The care time delays were lengthened enough in our context. This testifies to the lack of a codified strategy for STEMI care. It is essential to develop pre-hospital emergency medicine and sensitize the population and healthcare professionals.