Background: International guidelines have been published regarding the optimum time for revascularization either through fibronolysis or percutaneous coronary intervention) for ST elevation myocardial infarction patients seen at the emergency room (door-to-needle time of 60 minutes and door-to-balloon time of 90 minutes). Data around the world have shown a relationship between adherence to guidelines and occurrence of morbidity and mortality among these patients. Local data from the Philippine Heart Center (PHC) is examined. This study aims to compare the outcomes of STEMI patients seen at PHC according to adherence to recommend door-to-needle and door-to-balloon time.
Methods: This is a prospective cohort study involving patients who presented as ST elevation myocardial infarction without any fibrinolytic treatment done prior to ER consult. Information sheets were given out at the emergency room and the catheterization laboratory. The author, as well as the adult cardiology fellows and nurses assigned at the emergency room and cardiac catheterization laboratory, documented the specific events and procedures performed and the time it was done- patient's time of arrival at the ER or catheterization lababoratory, time when thrombolysis or percutaneous coronary intervention (PCI) was done. Outcomes were defined as in-hospital mortality, improvement of condition leading to discharge , or morbidities: life - threatening arrhythmia (ventricular tachycardia, ventricular fibrillation) hypotension, congestive heart failure, and others. Prolonged hospital stay due to complications like hospital-acquired infection and non-cardiac problems were not included.
Results: A total of 94 patients underwent PCI; 26 adhered to the door-to-balloon time, while 68 did not. There was no significant difference in mortality and complications up to 72 hours post-procedure in both groups, but there was statistically significant difference in the length of hospital stay, with shorter hospital stay in the group that adhered to recommend the door-to-balloon time. Subjects were few in the thrombolysis group, so no statistical analysis was done, but trends shows shorter hospital stay in the group that adhered to the recommended door-to-needle time, and with more procedure like PCI and CABG further done in the non- adherent group.
Conclusion: This study showed that in majority patients at the Philippine Heart Center who underwent emergency thrombolysis and PCI, the recommended door-to-needle and door-to-balloon time were not met. This has no effect on mortality and complications in all patient subgroup, but resulted to a shorter hospital stay in those who adhered to the guidelines.