Document Type
Article
Department
Internal Medicine (East Africa)
Abstract
Introduction: Current practice guidelines emphasize the importance of rapid reperfusion of patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to evaluate the current rate of compliance with evidence-based practice guidelines for the management of STEMI patients at a tertiary hospital in Kenya.
Methods: This was a retrospective chart review. Data on patient characteristics, emergency treatment, and outcomes were collected on adults admitted with a diagnosis of STEMI from January 2012 to February 2013.
Results: Data were collected for 45 patient presentations. 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 h of symptom onset. Within 10 min 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 of43% of the cases. Door-to- balloon time was29% 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 min 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 acute care systems to target early reperfusion of STEMI patients.
Publication (Name of Journal)
African Journal of Emergency Medicine
Recommended Citation
Wachira, B.,
Owuor, A.,
Otieno, H.
(2014). Acute management of ST-elevation myocardial infarction in a tertiary hospital in Kenya: are we complying with practice guidelines?. African Journal of Emergency Medicine, 4(3), 1-5.
Available at:
https://ecommons.aku.edu/eastafrica_fhs_mc_intern_med/17
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