Time to Medical Management in Patients Presenting with Non-ST Elevation Myocardial Infarction: A Retrospective Analysis of Two Teaching Hospitals

Background: It is clear that early administration of antiplatelet and antithrombotic therapy in patients presenting with Non-ST elevation MI (NSTEMI) is associated with improved outcomes. There are existing guidelines regarding early treatment in this patient population. We investigated how effectively patients are being managed for NSTEMI with respect to time to administration of indicated medical therapies in two teaching institutions. Methods: A retrospective analysis was performed on 100 consecutive patients with no prior history of coronary artery disease who presented to the Emergency Departments of two teaching hospitals affi liated with McMaster University with the diagnosis of NSTEMI (defi ned as ischemic symptoms in presence of elevated cardiac biomarkers with or without elec-trocardiographic changes). Times of medication administration were obtained from the nursing notes. Results: The mean age was 63.9 ± 14.1 years. The average time to administration of aspirin was 2.7 ± 4.3 hours, Unfrac-tionated or Low Molecular Weight Heparin 5.4 ± 5.0 hours, and Clopidagrel 10.8 ± 16.5 hours from time of triage. Duration of symptoms prior to presentation were longer in patients with left ventricular (LV) dysfunction (on echocardiography assessed in 73 patients) compared to patients with normal LV, (7.5 h ± 8.3 vs. 3.3 h ± 3.4 p = 0.006). The average age of patients who had ASA, Heparin, and Clopidagrel initiated within 3 hours was lower than those after 6 hours (60.1 ± 12.7 years vs 68.1 ± 14.4 years, p = 0.01). The average age for those who underwent angiography ± percutaneous coronary intervention