A Study of Prehospital Delay Patterns in Acute Myocardial Infarction in an Urban Tertiary Care Institute in Mumbai.

OBJECTIVE: There is now increasing awareness about the need for early diagnosis in patients presenting with chest pain. Pre-hospital delay remains a major hurdle in the institution of early reperfusion therapy, which is crucial in salvaging 'at-risk' myocardium and reducing adverse cardiovascular events following ST elevation myocardial infarction (STEMI). This study aims to determine the incidence and the determinants of delayed presentation STEMI and the potential impact of such delay on adverse cardiovascular outcomes.

METHODS: We prospectively evaluated all patients who were admitted in the emergency department of our hospital with STEMI from March 2014 to February 2016. Data was collected sequentially at the time of admission, discharge and during follow-up. Patients were evaluated with serial ECGs, continuous ECG monitoring and echocardiography.

RESULTS: Out of 1386 patients with STEMI, delayed presentation was seen in 1148 (> 2 hrs) and 805 (> 4 hrs) patients. The duration from onset of symptoms to the presentation in the emergency room (pre-hospital delay) was 228 ± 341minutes.The door to needle time was 34 ± 24 minutes. The major factors for pre-hospital delay were misinterpretation of symptoms (45%) and transportation problems (27%).

CONCLUSIONS: The problem of pre-hospital delay continues to remain a major hurdle in initiating timely reperfusion therapy in patients with acute STEMI. Lack of awareness and poor transportation facilities are the major contributors. It should be the goal of STEMI care programmes of the future to make a concerted effort to addressing these factors, in order to optimize the benefit of reperfusion therapy for this high risk group of patients.