Key result
STEMI fibrinolysis takes a median ~67 minutes, significantly exceeding ESC targets.
Why the study?
Timeous intervention by PCI or fibrinolysis can improve STEMI outcomes, but the median time from diagnosis to fibrinolysis in centres around Tygerberg Hospital was unknown.
What is the median time interval from diagnosis to fibrinolysis in STEMI patients presenting to centres in Cape Town, South Africa?
Observational (n=447)
Yes
What is the median time interval from diagnosis to fibrinolysis in STEMI patients presenting to centres in Cape Town, South Africa?
The vast majority of STEMI patients in this South African cohort experienced significant delays in receiving fibrinolysis, failing to meet the ESC recommendation of treatment within 10 minutes of diagnosis.
Delays to fibrinolysis persist in SA referral networks; leaves open whether targeted quality initiatives can achieve ESC targets in similar settings.
BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is one of the main contributors to morbidity and mortality in South Africa (SA). Timeous intervention by means of percutaneous coronary intervention (PCI) or fibrinolysis can significantly improve the outcome of STEMI. OBJECTIVES: To determine the median time interval between diagnosis and fibrinolysis in patients presenting to centres within the drainage area of Tygerberg Hospital, Cape Town, SA, and compare it with the European Society of Cardiology (ESC) recommendation of 10 minutes. METHODS: A retrospective medical record review of patients presenting to the abovementioned centres between 1 March 2017 and 28 February 2018 was performed. The primary presenting centre, time between diagnosis and fibrinolysis and discharge medication were recorded, in addition to other relevant demographic information. RESULTS: A total of 492 patients were identified, of whom 447 were included in the study. Three hundred and eighteen patients received fibrinolysis, of whom 18 (5.7%) were treated within 10 minutes of diagnosis. The median time interval between diagnosis and fibrinolysis was 67 (interquartile range (IQR) 32.5 -122.5) minutes. CONCLUSIONS: Most patients received fibrinolysis >10 minutes after diagnosis, which indicates suboptimal therapy when compared with the ESC guidelines. Future studies should investigate the factors prolonging this therapeutic delay.
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Beyers et al. (2020) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=447). Fibrinolysis vs. ESC guideline target of 10 minutes was evaluated on Median time interval between diagnosis and fibrinolysis (minutes). The median time from STEMI diagnosis to fibrinolysis was 67 minutes, significantly exceeding the ESC-recommended 10-minute target, with only 5.7% of treated patients receiving fibrinolysis within this timeframe.
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