Key result
African STEMI patients treated with fibrinolysis experienced a pooled mean door-to-needle time of 74.8 minutes, more than twice the 30-minute guideline target, with only 36.3% receiving timely treatment.
Why the study?
Timely fibrinolysis is crucial for STEMI reperfusion where primary PCI access is limited, but real-world door-to-needle times and guideline adherence in African hospitals had not been quantified continent-wide.
What is the real-world door-to-needle time for STEMI patients receiving thrombolysis in Africa, and does it meet guideline benchmarks?
Meta-Analysis (n=1,261)
Yes
What is the real-world door-to-needle time for STEMI patients receiving thrombolysis in Africa, and does it meet guideline benchmarks?
Effect estimate: 74.8 min (95% CI 44.4-105.2)
African STEMI patients experience door-to-needle delays more than twice the guideline target of 30 minutes, highlighting an urgent need for standardized reperfusion protocols and quality-improvement initiatives.
Real-world DTNT shortfalls in African hospitals may delay STEMI reperfusion; leaves open need for targeted quality initiatives and prospective trials.
Background Timely fibrinolysis remains the cornerstone of reperfusion for ST-elevation myocardial infarction (STEMI) in settings without reliable access to primary percutaneous coronary intervention (PCI). International guidelines recommend a door-to-needle time (DTNT) of 30 min or less. Aim We conducted the first continent-wide meta-analysis to quantify real-world DTNTs and adherence to guideline benchmarks in African hospitals. Methods We systematically searched PubMed/MEDLINE, Scopus, and Web of Science through July 2, 2025, for studies reporting DTNT for adult STEMI patients treated with thrombolysis in Africa. Pooled mean DTNT was estimated via random-effects meta-analysis with restricted maximum likelihood and Knapp–Hartung adjustment. Heterogeneity was assessed by Cochran's Q and I 2 , and sensitivity analyses evaluated robustness. Results Across 12 eligible studies encompassing a total of 2193 STEMI patients, about 1261 individuals (57.5%) received thrombolytic therapy. Among the 11 studies reporting mean reperfusion times (1011 patients), the overall pooled mean DTNT was 74.8 min (95% confidence interval: 44.4–105.2; I 2 = 99.4%), substantially exceeding the recommended benchmark. Notably, only 36.3% of thrombolyzed patients achieved a DTNT of ≤30 min. Furthermore, none of the included study cohorts reported an overall mean DTNT within 30 min. Conclusion African STEMI patients experience door-to-needle delays more than twice the guideline target, with fewer than 4 in 10 receiving timely fibrinolysis. In such settings lacking widespread PCI, implementation of standardized reperfusion protocols, optimized in-hospital workflows, and targeted quality-improvement initiatives is urgently needed to accelerate fibrinolysis, maximize myocardial salvage, and reduce adverse cardiovascular outcomes.
No takes yet. Share an insight, caveat, or question.
Sama et al. (2025) conducted a meta-analysis in ST-elevation myocardial infarction (STEMI) (n=1,261). Fibrinolysis vs. Guideline benchmark (≤30 min) was evaluated on Pooled mean door-to-needle time (DTNT) (74.8 min, 95% CI 44.4-105.2). African STEMI patients treated with fibrinolysis experienced a pooled mean door-to-needle time of 74.8 minutes, more than twice the 30-minute guideline target, with only 36.3% receiving timely treatment.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: