Mode of Referral and Time to Primary PCI in ST-Elevation Myocardial Infarction
DOI:
https://doi.org/10.54133/ajms.v9i2.2553Keywords:
Emergency department, Ischemic time, PCI, STEMI, Transport modeAbstract
Background: ST-elevation myocardial infarction (STEMI) is a critical emergency where timely reperfusion via primary percutaneous coronary intervention (PCI) is vital. Delays in treatment, particularly during referral or transfer, can severely worsen patient outcomes. Objective: To evaluate transport modes and treatment delays among STEMI patients, focusing on critical intervals from pain onset to first medical contact (FMC) to electrocardiogram (ECG), ECG to PCI, FMC to PCI, and total ischemic time to evaluate factors influencing timely reperfusion and patient outcomes. Methods: This retrospective study included 152 STEMI patients (25–97 years) at Shar Teaching Hospital, Sulaimani, from November 2024 to May 2025. Data on demographics, transport mode, and key time intervals (pain-FMC, FMC-ECG, ECG-PCI, FMC-PCI, and total ischemic time) were analyzed. Results: Significant delays were observed in STEMI treatment processes and timelines. Pain to FMC averaged 11.08± 8.20 hours (13.8% < 30min). FMC to ECG was 9.68±2.99 min (71.7% <10min). ECG to PCI was 1.31±1.60hr (69.1% <1.0hr), and FMC to PCI was 1.46±1.59 hr (67.8% <1.5hr). Total ischemic time was 12.55±18.17 hr (4.6% <2.0 hr). Most patients (71.7%) arrived by private vehicles, while only 28.3% used Emergency Medical Services (EMS) transport, affecting outcomes. Conclusions: The study identified major delays in pain-to-FMC and total ischemic times, mainly due to low EMS use. In-hospital times (FMC-ECG, ECG-PCI) met guidelines, indicating efficient hospital care. Enhancing EMS utilization and prehospital transport could further reduce delays and improve outcomes.
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