Clinical Review: Management of Patients with Acute ST-Elevation Myocardial Infarction

Aims: The aim was to assess the quality of practice provided to acute ST-elevation myocardial infarction (STEMI) patients at the cardiac center, within a specified time frame and identify possible areas of improvement.

Settings and design: This is a retrospective standards-based clinical review, including adults diagnosed with acute STEMI between January 1, 2016 and January 1, 2017 of cases admitted and managed at the respective cardiac center.

Subjects and methods: The study was designed according to recommendations provided by the National Institute for Health and Care Excellence guidelines: "The acute management of myocardial infarction with ST-segment elevation;" alongside, the local standard: door-to-balloon time ≤90 min, adopted from the American Heart Association.

Statistical analysis used: Data analysis was done through excel and SPSS for advanced statistical calculations. P < 0.05 was considered to be statically significant.

Results: In total, 277 patients were included in the study. About 72% underwent primary percutaneous coronary intervention with 62 min as median door-to-balloon time. Door-to-balloon time >90 min was significantly higher when patients presented outside official hospital hours (P = 0.039). Transradial route was chosen in 77.7% of the cases.

Conclusions: Practice at the cardiac center was found to show good compliance with the guidelines. However, door-to-balloon time for procedures performed out of official hospital working hours was slightly outside the recommended limit.