Factors Affecting Total Ischemic Time of Patients with ST-elevation Myocardial Infarction: A Cross-sectional Study from a Tertiary Care Hospital in Kerala, India

Background: Cardiovascular diseases have now become the leading cause of mortality in India. The mortality rate is observed to be higher in primary percutaneous coronary intervention (PPCI) patients with longer total ischemic time (TIT). The lack of awareness about the symptoms of acute coronary syndrome (ACS) delays the identification of this medical emergency and prolongs the TIT. The study of composition of TIT and the reasons for its prolongation will help to improve the outcome of ACS. Objectives: The objectives of this study were as follows: (1) to estimate the mean TIT and the proportion of patients with TIT <1 h (the golden hour), admitted to Government Medical College Thiruvananthapuram, with ST-elevation myocardial infarction (STEMI) who underwent PPCI and (2) to study the factors influencing the TIT as those in the (a) prehospital phase – the time from the onset of chest pain till arrival to the hospital where intervention is being carried out and (b) hospital phase – the time from the arrival at the hospital to the time of intervention. Methodology: The study assessed total ischemic time in STEMI patients who underwent PPCI, through a cross-sectional study investigating mean TIT, influencing factors, and proportion of Patients with TIT <1 h (the golden hour). The calculated sample size, 104, was met using a questionnaire and the case records. The data were entered in Excel and analyzed using SPSS. Results: No patients in the study population arrived within 1 h of symptom onset. The mean TIT was 363.10 min with standard deviation of 156.809 and the median TIT was 330.00 min (interquartile range is 225.00). Unlike other similar studies, there were no significant associations with age, gender, and social and educational status of the patient. Majority of the study population were not aware about the symptoms of ACS. Mode of transport, past history, family history, time of onset of symptoms, and time of arrival at the percutaneous coronary intervention (PCI) center were found to be significantly associated with TIT. Conclusion: This study assessed the major patient-related and system-related factors causing the prolongation in TIT. This will help us to formulate and implement the strategies to significantly shorten the delay in revascularization and improve the outcome of patients admitted with STEMI. For decreasing the patient-related delay, creating public awareness regarding the identification of ischemic symptoms and accessing immediate medical care is paramount The early diagnosis and referral from the first medical contact or non-PCI center and rapid triage at the PCI center improves the system-related delay and will improve the mortality rate and outcomes of the patients.