ISSN 1016-5169 | E-ISSN 1308-4488
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Appropriateness of the current guidelines on reperfusion treatment for patients applying to our hospital with ST-segment elevation acute myocardial infarction [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2012; 40(6): 493-498 | DOI: 10.5543/tkda.2012.68047

Appropriateness of the current guidelines on reperfusion treatment for patients applying to our hospital with ST-segment elevation acute myocardial infarction

Şükrü Karaarslan1, Yusuf İzzettin Alihanoğlu2, Bekir Serhat Yıldız2, Osman Sönmez3, Ahmet Soylu4, Ahmet Bacaksız3, İhsan Alur5, Kurtuluş Özdemir4, Akif Düzenli4
1Department of Cardiology, Nigde State Hospital, Nigde, Turkey
2Department of Cardiology, Denizli State Hospital, Denizli, Turkey
3Department of Cardiovascular Surgery, Denizli State Hospital, Denizli, Turkey
4Department of Cardiology, Bezmialem University Faculty of Medicine, İstanbul, Turkey
5Department of Cardiology Selcuk University, Meram Faculty of Medicine, Konya, Turkey


OBJECTIVES
This study investigated the appropriateness of treatment for patients admitted with ST-segment elevation myocardial infarction (STEMI) according to the current guidelines. We also aimed to determine in-patient and out-patient factors affecting optimal reperfusion therapy.

STUDY DESIGN
The reperfusion therapy of 176 patients with STEMI was determined. The time period from first contact with a healthcare provider to the time of balloon inflation (door to balloon time), and from the time period of first contact with a healthcare provider to the time of initiation of a thrombolytic (door to needle time) were calculated. Similarly, the time from admission at the emergency service (ES) of our hospital after referral to the moment of balloon inflation (ES to balloon time) and the period from admission to ES at our hospital to the moment of initiation of a thrombolytic (ES to needle time) were calculated. In order to determine the amount of in-hospital delay, the time from ES admission to the call to the cardiology department and the time for the cardiologist to evaluate the patient and transfer time were recorded. Whether the referring physician was a cardiologist and the effect of work hours on the reperfusion period was also recorded.

RESULTS
The door to balloon time in the referred patient group was calculated as an average of 228 minutes, while the time for patients directly admitted to ES was calculated as an average of 98 minutes. Patients referred for the mechanical reperfusion period compared to American Heart Association (AHA) guidelines consisted of only 6% of the eligible patients, while according to the European Society of Cardiology (ESC) guidelines 13% of patients were appropriate. Patients who were directly admitted to ES, experienced rates according to AHA guidelines and 73% experienced these rates according to ESC guidelines. We also found no significant effect of working hours or referring physician’s specialty (cardiologist or other) on reperfusion time.

CONCLUSION
Compliance rates of reperfusion therapy for patients presenting with STEMI was very low. We realized, when taking into consideration the reasons for delay in terms of both health community and the policy of the country, it is obvious that we have to take strict measures.

Keywords: Angioplasty, balloon, coronary, myocardial infarction; myocardial reperfusion; practice guidelines as topic; thrombolytic therapy; time factors.

Corresponding Author: Bekir Serhat Yıldız, Türkiye
Manuscript Language: English
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