Abstract

Background: Despite significant advances in the management of patients with ST-segment elevation myocardial infarction, the issues of reperfusion therapy and its effectiveness are still extremely important, despite the large number of positive results of studies on its use. Unfortunately, it is still quite common in small hospitals and in the prehospital stage that medical workers refuse to carry out reperfusion therapy without sufficient justification.

Aim: To assess the reasons for refusing reperfusion therapy in STEMI patients admitted to the primary vascular unit (PVU) or a regional vascular center (RVC) to optimize management tactics.

Methods: The study was prospective, open, non-randomized. The study included all patients and STEMI from the 1st to the 16th of each month throughout 2018. A total of 848 patients were included. Observation of the surveyed persons and collection of endpoints continued for 18 months.

Results: Regression analysis showed that nitrate intake (OR 0.661, 95% CI 0.402-0.995) in patients was associated with any type of reperfusion, the presence in patients with chronic heart failure (CHF) and chronic kidney disease (CKD) were associated with rejection from reperfusion therapy. It should be noted that if the patient lived outside the regional center, the chances of receiving adequate reperfusion decreased (OR 2.911, 95% CI 2.006-4.222). Duration of symptoms longer than 12 hours also reduced the chances of reperfusion therapy. The presence of arterial hypertension (OR 1.860 95% CI 1.495-2.041, p = 0.034) and / or CHF (OR 1.522 95% CI 1.201-2.347, p = 0.047) was a factor that led to the refusal of reperfusion therapy in patients with STEMI living outside the regional center.

Conclusion: The characteristic features associated with the refusal of reperfusion were identified. This was chronic heart failure, chronic kidney disease and living outside the regional center, which significantly reduced the chances of receiving this type of therapy. An expected duration of STEMI symptoms of more than 12 hours was associated with refusal.

Keywords: Reperfusion therapy, STEMI, myocardial infarction