Key result
Delayed pain-to-needle time (>3 hours) was associated with significantly higher rates of post-infarct angina (22.9% vs 2.7%, p<0.0001) and other in-hospital complications compared to early presentation.
Why the study?
It is unclear whether door-to-needle time significantly impacts STEMI patients presenting more than three hours after chest pain onset, particularly in developing countries lacking established pre-hospital triage systems.
Does shorter door-to-needle time reduce in-hospital complications in STEMI patients undergoing thrombolysis who present with delayed pain-to-needle time (>3 hours)?
Cohort (n=300)
No
Does shorter door-to-needle time reduce in-hospital complications in STEMI patients undergoing thrombolysis who present with delayed pain-to-needle time (>3 hours)?
Absolute Event Rate: 22.9% vs 2.7%
p-value: p=<0.0001
Shorter door-to-needle time (≤30 minutes) for thrombolysis significantly reduces in-hospital complications even in STEMI patients who present late (>3 hours after symptom onset).
Delayed thrombolysis times may raise STEMI complications; leaves open optimal targets for prospective trials.
Background Myocardial infarction is a life-threatening event, and timely intervention is essential to improve patient outcomes and mortality. Previous studies have shown that the time to thrombolysis should be less than 30 minutes of the patient's arrival at the emergency room. Pain-to-needle time is a time from onset of chest pain to the initiation of thrombolysis, and door-to-needle time is a time between arrival to the emergency room to initiation of thrombolytic treatment. Ideally, the target for door-to-needle time should be less than 30 minutes; however, it is unclear if the door-to-needle time has a significant impact on patients presenting later than three hours from the onset of pain. As many of the previous studies were conducted in first-world countries, with established emergency medical services (EMS) systems and pre-hospital ST-elevation myocardial infarction (STEMI) triages and protocols, the data is not completely generalizable to developing countries. We, therefore, looked for the impact of the shorter and longer door-to-needle times on patient outcomes who presented to the emergency room (ER) with delayed pain-to-needle times (more than three hours of pain onset). Objective To determine the impact of delayed pain-to-needle time (PNT) with variable door-to-needle time (DNT) on in-hospital complications (post-infarct angina, heart failure, left ventricular dysfunction, and death) in patients with ST-elevation myocardial infarction (STEMI) who underwent thrombolysis. Methods and results A total of 300 STEMI patients who underwent thrombolysis within 12 hours of symptoms onset were included, which were divided into two groups based on PNT. These groups were further divided into subgroups based on DNT. The primary outcome was in-hospital complications between the two groups and between subgroups within each group. The pain-to-needle time was ≤3 hours in 73 (24.3%) patients and >3 hours in 227 (75.7%) patients. In-hospital complications were higher in group II with PNT >3 hours (p <0.05). On subgroup analysis, in-hospital complications were higher with longer door-to-needle time in group II (p<0.05); however, there was no difference in complications among group I. Conclusion Our study is consistent with the fact that shorter door-to-needle time, even in patients with delayed PNT (>3 hours), has a significant impact on in-hospital complications with no difference in mortality.
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Iqbal et al. (2022) conducted a cohort in ST-elevation myocardial infarction (n=300). Delayed pain-to-needle time (>3 hours) vs. Early pain-to-needle time (≤3 hours) was evaluated on Post-infarct angina (as a component of in-hospital complications) (p=<0.0001). Delayed pain-to-needle time (>3 hours) was associated with significantly higher rates of post-infarct angina (22.9% vs 2.7%, p<0.0001) and other in-hospital complications compared to early presentation.
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