title: Delayed presentation of acute coronary syndrome: a challenge in its early management.
abstract: BACKGROUND
  The time of presentation of acute coronary syndrome from the onset of chest pain determines the treatment modality and prognosis. Delayed presentation is associated with a poor outcome. In the present study, we tried to find out the causes of late presentation of ACS in a tertiary care center in the eastern part of Nepal.
  
  
  METHODS
  It was a cross-sectional descriptive study that included 100 consecutive patients with ACS presenting to our institute over a period of 8 months. They were studied for their demographic profile, delay in presentation, the management done at the local centers and their final diagnosis.
  
  
  RESULTS
  We found that patients living within Dharan City reached BPKIHS within 20 hours of the onset of chest pain while those from outside the city who came directly reached within 63 hours. Other patients reached their respective local centers (health posts, district hospitals and private clinics) within 39 hours. The commonest cause of delay was vehicular problem followed by unnecessary delay at the local centers. The work up for chest pain was inadequate in these centers. Late presentation to our institute significantly affected the optimal management.
  
  
  CONCLUSIONS
  We found that significant number of patients with ACS from eastern Nepal presented late in our tertiary care center. In order to improve ACS outcome in this region, we advise equipping the local centers with electrocardiogram machines, improvement in ambulance services and a greater emphasis on coronary artery disease awareness programs as well as initiating preventive measures.
authors.affiliation: Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. acharya.pramod@gmail.com
authors.forename: P
authors.initials: P
authors.lastname: Acharya
authors.forename: R R
authors.initials: RR
authors.lastname: Adhikari
authors.forename: J
authors.initials: J
authors.lastname: Bhattarai
authors.forename: N R
authors.initials: NR
authors.lastname: Shrestha
authors.forename: S K
authors.initials: SK
authors.lastname: Sharma
authors.forename: P
authors.initials: P
authors.lastname: Karki
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D004562:Electrocardiography / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal; D012017:Referral and Consultation; D012423:Rural Health; D013997:Time Factors; D014195:Travel