ST elevation Myocardial Infarctions at a rural Emergency Department ­ 4 year experience in South Trinidad

ABSTRACT

Background: ST elevation Myocardial Infarctions (STEMIs) are one of the most common treatable causes of death and morbidity in Trinidad & Tobago. Bodies such as the American Heart Association (AHA) have recognised that early identification and treatment using thrombolytics or Primary Coronary Intervention (PCI) of STEMIs is crucial to improving patient outcomes, and have made recommendations for ideal critical actions in the management of STEMIs. Data on the performance of Emergency Departments to deliver these actions is poor in many developing countries, but at the same time, are important to measure in order to drive improvement in patient care. Objectives & Methods: We aimed to determine the quality metrics and six (6) month mortality outcomes in STEMI patients who presented to the Emergency Department, Siparia District Health Facility. Medical records for all patients receiving thrombolytic therapy were obtained over the period January 2011 ­ December 2014. Data was extracted and reviewed and 6 month telephone follow-up via was performed for these patients. Descriptive analysis was undertaken using Microsoft Excel. Results: Seventy- seven (77) patients received thrombolysis but only sixty-one (61) had complete documentation. There were almost 4 times as many men than women (77.8% of males and 20.3% of females), with the mean ages being 58.8 years and 66.1 years respectively. The most common risk factor was hypertension, followed by diabetes mellitus. The most common type of STEMI was of the inferior wall. The median Door to ECG time was 10 minutes with 52.5% of patients achieving a Door to ECG time of less than 10 minutes. The median Door to Needle time was 70 minutes with only 8.2% of patients having a Door to needle time of less than 30 minutes. Approximately half of all patients thrombolysed showed greater than 50% ECG resolution. 94.3% of patients were alive at 6 months. Conclusions: Although the AHA recommended standards for thrombolysis were not met fully, these results show that despite the limitations of practice in a rural developing world setting, the majority of patients received timely and appropriate care. Although showing better performance than other local centers, changes within the system are still required to meet first world standards, improve patient care and potentially improve mortality. Hypertension and Diabetes are major risk factors in our population.