Volume : 08, Issue : 07, July – 2021

Title:

16.ASSESSING THE EFFECTIVENESS AND IMPROVEMENT IN THE DOOR TO NEEDLE TIME OF STREPTOKINASE IN ST-ELEVATION MYOCARDIAL INFARCTION IN CORONARY CARE UNIT OF A TERTIARY CARE HOSPITAL IN A DEVELOPING COUNTRY

Authors :

Adnan Khan, Faridoon Masood, Muhammad Hammad Sharif*, Shahsawar khan, Jasia Bukhari, Shakir Ghaffar, Faizullah, Madeeha Khaleeque

Abstract :

Introduction: Early start of treatment including coronary revascularisation has been recognized as crucial variable in the outcome of acute ST-segment Elevation Myocardial Infarction (STEMI), timely treatment with antithrombotic agents plays a key role in reducing an AMI mortality rate.
Objectives: The present study aimed to assess the time interval between the admission of ST-Elevation MI suspected patients and treatment initiation in coronary care unit.
Methods: This cross-sectional study was conducted on 910 patients admitted to the emergency department Coronary care unit of Hayatabad Medical Complex, Peshawar, from 1st January 2018 to 31st December2019. To analyze the data, student t- test and analysis of variance were used.
Results: In this study 431 female and 479 male subjects were included, respectively. The mean time to receive the first dose of streptokinase was 28 minutes, varying from 37 minutes in January, February and March, 34 minutes in April, May and June 24 minutes in July, August and September, and 20 minutes in October, November and December. Major adverse cardiac events that is arrhythmias, heart blocks, heart failure, were reduced in those patients with door to needle time less than 30 minutes.
Conclusions: The door-to-needle (DTN) time, in a standard setting, is recommended to be less than 30 minutes. According to the results of this study, the DTN time is improved in last three months of our study. Different variables including emergency staff, physicians, patient’s characteristics, and environmental/physical factors induced this difference.
Keywords: Acute Myocardial Infarction, Emergency Service, Needle Stick Injuries, Streptokinase, Arrhythmia, heart block, heart failure.

Cite This Article:

Please cite this article in press Muhammad Hammad Sharif et al., Assessing The Effectiveness And Improvement In The Door To Needle Time Of Streptokinase In St-Elevation Myocardial Infarction In Coronary Care Unit Of A Tertiary Care Hospital In A Developing Country.., Indo Am. J. P. Sci, 2021; 08(07).

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References:

1. Yusuf S, Reddy S, Ounpuu S. Global burden of cardiovascular diseases: Part 1: General considerations, the epidemiological transition, risk factors and impact of urbanization. Circulation 2001;104:2746-53.
2. Statistics South Africa. Mortality and Causes of Death in South Africa, 2008. Findings from Death Notifications. http://www.statssa.gov.za
3. Armstrong PW, Bogaty P, Buller CE. The 2004 ACC/AHA guidelines: a perspective adaptation for Canada by the Canadian Cardiovascular Society Working Group. Can J Cardiol 2004;20:1075-79.
4. de Boer MJ, Hoorntje JC, Ottervanger JPl. Immediate coronary angioplasty versus intravenous streptokinase in acute myocardial infarction: left ventricular ejection fraction, hospital mortality and reinfarction. J Am Coll Cardiol 1994;23:1004-08.
5. Stone GW, Grines CL, Browne KF. Implications of recurrent ischemia after reperfusion therapy in acute myocardial infarction: a comparison of thrombolytic therapy and primary angioplasty. J Am CollCardiol 1995;26:66-72.
6. Weaver WD, Simes RJ, Betriu A. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA 1997;278:2093-98.
7. Wilcox RG, von der Lippe G, Olsson CG. Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction. Anglo-Scandinavian Study of Early Thrombolysis (ASSET). Lancet 1988;8610:525-530.
8. Second International Study of Infarct Survival (ISIS-2) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988;8607:349-360.
9. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 1994;343: 311.
10. Boersma E, Maas AC, Deckers JW. Early thrombolytic treatment in acute myocardial infarction: Reappraisal of the golden hour. Lancet 1996;9030:771-75.
11. Rawles JM (GREAT Group). Quantification of the benefit of earlier thrombolytic therapy: Five-year results of the Grampian Region Early Anistreplase Trial (GREAT). J Am CollCardiol 1997;30:1181-86.
12. Emil L, Fosbol, Christopher B, James G. Monk JL. The Impact of a State wide pre-hospital STEMI strategy to bypass hospitals without percutaneous coronary intervention capability on treatment times .Circulation 2012;112:1184346.
13. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK. ACCF/AHA Guideline for the Management of STElevation Myocardial Infarction: a Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, J Am CollCardiol 2013; 61 :e78-e140)
14. Kuppuswamy VC, WebbeD , Gupta S. Meeting the NSF targets for door-to-needle time in acute myocardial infarction – the role of a bolus thrombolytic. Br J Cardiol 2006;13:36-41.
15. Steg PG, James SK, Atar D, Badano LP, BlömstromLundqvist C. Guidelines for the management of acute myocardial infarction in patients presenting with STsegment elevation, Eur Heart J 2012; 33: 2569-2619
16. Peterson ED, Roe MT, Mulgund J.Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA. 2006; 295:1912– 20.
17. McNamara RL, Herrin J, Wang Y. Impact of delay in doorto-needle time on mortality in patients with ST-segment elevation myocardial infarction. Am J Cardio.2007; 100:1227–32.
18. McNamara RL, Wang Y, Herrin J. Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. J Am CollCardiol. 2006; 47:2180– 86.
19. Peterson ED, Shah BR, Parsons L. Trends in quality of care for patients with acute myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J. 2008; 156:1045–55
20. Yiadom, MaameYaa AB. Performance of Emergency Department Screening Criteria for an Early ECG to Identify ST Segment Elevation Myocardial Infarction. Journal of the American Heart Association 6.3 (2017): e00352
21. Atzema CL, Austin PC, Tu JV, Schull MJ. Emergency department triage of acute myocardial infarction patients and the effect on outcomes. Ann Emerg Med. 2009; 53:736–45.
22. Huynh T, O’Loughlin J, Joseph L. The AMI-QUEBEC Study Investigators. Delays to reperfusion therapy in acute STsegment elevation myocardial infarction: results from the AMI-QUEBEC Study CMAJ 2006; 175(12):1527-32.
23. Sarwar A, Xavier AA, Ragachandana K, Dhanapal CK, Sudarshan S. Evaluation of door to needle time and predisposing factor to it in a tertiary Care Hospital, Chidambaram.” PharmaTutor 4.11 (2016): 33-36.
24. Tsai CL, David J, Magid MD. Quality of Care for acute myocardial infarction in 58 U.S. emergency departments. AcadEmerg Med 2010;17:940-50.
25. Jehangir W, Daood MS, Khan M. Evaluation of the door-to needle time in patients undergoing fibrinolytic therapy after acute myocardial infarction. Pak J Physiol 2009;5(2):38-39.
26. Masurkar VA, Kapadia FN, Shirwadkar G. Evaluation of the door-to-needle time for fibrinolytic administration for acute myocardial infarction. Indian Journal of Critical Care Medicine 2005; 9(3):137-40.
27. Abba AA, Wanni BA, Rahmatullah RA. Door-to-needle time in administering thrombolytic therapy for acute myocardial infarction. Saudi Med J 2003; 24(4):361-64.
28. Zed PJ, Abu-Laban RB, Cadieu TM. Fibrinolytic administration for acute myocardial infarction in a tertiary ED: Factors associated with an increased door-to-needle time. Am J Emerg Med 2004;22:192-196.
29. Massel D. Observer variability in ECG interpretation for thrombolysis eligibility: Experience and context matter. J Throm Thrombolysis 2000;15(3):131-40.
30. Ho MT, Eisenberg MS, Litvin PE. Delay between onset of chest pain and seeking medical care. The effects of public education. Ann Emerg Med 1989;18:727-731.
31. George L, Ramamoorthy L, Satheesh S, Saya RP. Prehospital delay and time to reperfusion therapy in ST elevation myocardial infarction. J Emerg Trauma Shock 2017;10:64-69
32. Ali S, Sharif H, Shehzad K. Door to needle time and its impact on successful thrombolysis. JRMC; 2012;16(1):3-5
33. Venkatachelam R, Adilakshmi B, Manohar T, Rao M, Abbaiah S.Factors affecting time to arrival in hospital among patients with acute myocardial infarction (MI). Journal of Scientific and Innovative Research 2015; 4(2): 109-14.
34. Mark J, and Caesar J. Improving door-to-needle times for patients presenting with ST-elevation myocardial infarction at a rural district general hospital. BMJ Quality Improvement Reports 2016; 5.1:673-76.
35. Puymirat N and Etienne M.Prognostic impact of noncompliance with guidelines-recommended times to reperfusion therapy in ST-elevation myocardial infarction. The FAST-MI 2010 registry. European Heart Journal: Acute Cardiovascular Care 2017; 6: 26-33.