ABSTRACT

Objective: To measure delay factors in patients undergoing primary percutaneous coronary intervention

Study Design: Cross-sectional study

Place and Duration of Study: Department of Cardiology, National Institute of Cardiovascular Disease, Karachi from 1st January 2019 to 31st July 2019.

Methodology: Ninety-seven patients of acute ST-elevation myocardial infarction of age >18 and <65 years and either gender with the indication for primary percutaneous coronary intervention were included in the study. Patients whose symptoms onset >12 hours, having unstable conditions i.e. arrhythmias, cardiac arrest, severe hypertension, and indication or history for coronary artery bypass grafting were excluded.

Results: The mean age was 52.70±6.25 years and the mean duration of symptoms was 163.33±106.16 minutes. The majority of patients were males 89 (91.75%). Fifty-nine (60%) patients between 50-59 years, 23 (23.7%) between 40-49 years while 15 (15.5%) between 60-65 years. Forty-seven (48.5%) patients belonged to lower socioeconomic status. Forty (41%) patients were from urban areas, 43 (44.33%) peri-urban areas of Karachi while only 14 (14.43%) patients were referred from rural areas. The frequency of door to balloon delay (D2B delay) was found in 52 (53.6%). Misinterpretation by the patient (68%) for the symptoms and transportation delay (52.6%) were the two most common factors.

Conclusion: Pre-hospital factors (misinterpretation by the patients and first medical contact person and transportation delay) are the major factor that causes D2B delay. Other contributing factors are delay in diagnosis, unavailability of a consultant cardiologist, delay in readiness of catheterization lab, and procedure-related delays. Keywords: Myocardial infarction, Acute ST-elevation myocardial infarction (STEMI), Primary percutaneous coronary intervention (PCI), Door to balloon delay, Coronary artery bypass grafting (CABG)