Thrombolysis on first contact saves minutes and myocardium
OBJECTIVE: To compare the door to needle time (DNT), for thrombolysis in acute myocardial infarction, at the new chest pain clinic at emergency room, with the old CCU at the cardiology Department LRH Peshawar.
METHODOLOGY: This was a retrospective study conducted at Lady reading Hospital, Peshawar. Two data sets were acquired from hospital records. One for CCU at the cardiology department covered the span from 1st July till 30th sept: 2010. The other for the chest pain clinic emergency department covered the span from 1st April to 15th May, 2017. All the patients having ST elevated acute myocardial infarction eligible for thrombolytic therapy were included in the study. Door to needle time was calculated in both the groups. Comparison of DNT between both groups was made by using student t-test with p-≤0.05 taken as significant. Comparison between other base line qualitative characteristics was made by using chi square test with p-≤0.05 taken as significant.
RESULTS: Total of 140 patients were enrolled in CCU group with mean age of 57.96±13.5 years. Out of these 60% were male. While 209 patients were enrolled in ED group with mean age of 58.85±6.9 years. Of these 65.1% were males. Mean DNT in CCU group was 72.42±50.85 minutes while in ED was 31.96±16.6 minutes with p-value 0.0001 with a reduction of 41.30 minutes in the DNT. DNT of <30 minutes and between 30-60 minutes was achieved in 7.1% and 62.8% in CCU group while in rest it was more than 60 minutes. In ED group the DNT achieved was <30 minutes in70.8% and 30-60 minutes in 29.2% of patients while none fell in category of >60 minutes.
CONCLUSION: The door to needle time for thrombolytic administration for acute myocardial infarction was significantly less at the chest pain clinic at emergency room than at the CCU at cardiology department.