Evaluating in-hospital delay for fibrinolytic therapy of myocardial infarction patients with acute ST-elevation in Kashan Shahid-Beheshti hospital during 2007-2010

Fibrinolytic therapy of myocardial infarction (MI) should be started as soon as possible after the onset of symptoms. Since efforts to reduce pre-hospital delay have shown limited success in treatment, substantial emphasis should be placed on reducing in-hospital delay. This study aimed to evaluate the in-hospital delay for fibrinolytic therapy in Kashan Shahid-Beheshti hospital during 2007-2010. This cross-sectional study was performed on 300 patients with ST-elevated myocardial infarction. Exclusion criteria were the previous MIs, incomplete data regarding the time of hospital admission or fibrinolysis and patients who were referred to the hospital by physicians outside the hospital. Demographic data, the time of symptom onset, admission time and fibrinolysis were collected and then analyzed. Two hundred and twenty-five (75.3%) out of 300 patients were male. Most patients (63.7%) were in the age range of greater than 55 years. The mean of in-hospital delay was 57 minutes. Sixty-three percent of patients experienced an unacceptable delay of greater than 30 minutes and only 37% of the patients experienced an acceptable delay of equal or less than 30 minutes. The mean of pre-hospital delay was 136 minutes. Half (53.7%) of the patients had a total delay of less than 3 hours. There was no association between the in-hospital mortality and total or in-hospital delay. The majority of patients (63%) had an optimal in-hospital delay and the mean door-to-needle time was about two times more than the optimal. Furthermore, identifying and modifying of the contributing factors in triage and emergency wards seem to be effective for decreasing in-hospital delay in reperfusion therapy.