Emergency management of ST-elevation myocardial infarction in a tertiary hospital in Kenya: Are we complying with practice guidelines?

Introduction Current practice guidelines emphasize the importance of rapid reperfusion of patients with ST-elevation myocardial infarction (STEMI). While, several large Acute Coronary Syndrome (ACS) registries have been conducted in North America and Europe, there is very little data on the compliance with evidence based guidelines in sub-Saharan Africa. The aim of our study was to evaluate the characteristics, emergency treatment and outcomes of patients with STEMI admitted at a tertiary hospital in Kenya. Methods This was a retrospective chart review. Data on patient characteristics, emergency treatment, and outcomes were collected on 45 adults admitted with a diagnosis of STEMI from January 2012 to February 2013. Results There were 37 male patients (82%). The mean age was 59.7 ± 3.8 years. Of the 45 patients, 23 were Asian (51%), 18 were Black (40%) and four were Caucasian (9%). Thirty five patients (78%) presented within 12 hours of symptom onset. Within 10 minutes of arrival to the hospital, 40 patients (89%) had electrocardiographs performed and 39 patients (87%) were reviewed by a doctor. Medications given on presentation were aspirin (98%), clopidogrel (91%) and anticoagulants (73%). All patients received reperfusion therapy. Twenty eight patients (62%) received fibrinolytic therapy and 17 patients (38%) had primary percutaneous coronary intervention. Door-to-needle time of <30 min was achieved in 43% of the cases. Door-to-balloon time was <90 min in 35% of the cases. All the patients survived to hospital discharge. The average length of stay was 5.3 ± 1.0 days. In-hospital complications occurred in six patients (13.3%). These included bleeding (three patients), stroke (one patient) and cardiogenic shock requiring intra-aortic balloon pump support (two patients). Conclusion Whereas the majority of STEMI patients are evaluated within 10 minutes of presentation, less than 50% receive reperfusion therapy within the recommended time frame. While there are attempts to comply with evidence based guidelines in resource-limited settings, there is a need to improve emergency care systems to target early reperfusion of STEMI patients.