The management of one hundred and four cases of STEMI in a cardiology department with no cath lab: Do we respect delays?

Introduction ST elevated myocardial infarction (STEMI) is a medical emergency. Moreover, in some developing countries, it is not always easy to access to the transluminal coronary angioplasty (TCA) hence the importance of thrombolysis and respecting delays. Methods This is a retrospective study over 18 months done in our cardiology department enrolling 104 patients hospitalized for STEMI and thrombolysed with tenecteplase after their admission in the cardiac intensive care unit (CICU). We will focus here on the delay of the onset of chest pain to fibrinolysis and first medical contact to fibrinolysis. Results All the patients were thrombolysed with tenecteplase since we don’t have an easy access to a cath lab. Fifty-three percent of our patients consulted during the night shift. One third of our patients consulted in the first 2 hours and two third in the first 4 hours. 1/Delay of the onset of chest pain to thrombolysis: the average delay between the onset of chest pain to thrombolysis is 4.19 ± 2.7 hours with extremes of 20 minutes and 12 hours. Forty-six percent of our patients were thrombolysed in the first 3 hours, 37.5% were thrombolysed between three and six hours and 16.5% between six and twelve hours. 2/Delay of first medical contact to thrombolysis: all patients were thrombolysed after their admission in the CICU. Ninety-six percent of them were hospitalized and thrombolysed in less than one hour after their first medical contact in the emergency room. Only 2.9% were thrombolysed after the first hour of their first medical contact and only one patient was thrombolysed 4 hours after its admission for uncertain diagnosis. The delay door to needle recommended by the European society of cardiology is 30 minutes; unfortunately, we are out of recommendations. Conclusion Acute myocardial infarction is a real emergency: “time is myocardium”, that is why we have to encourage the Pre-hospital thrombolysis or at least the thrombolysis in the emergency room to reduce the door to needle delay.