title: Damas hospital compliance to American College of Cardiology reperfusion therapy during acute ST-elevation myocardial infarction.
abstract: Despite improvements in care, up to one-third of patients presenting with ST-elevation myocardial infarction (STEMI) within 12 hours of symptom onset receive no reperfusion therapy. Despite effective pre- and in-hospital reperfusion strategies becoming standard over the past two decades, time-to-admission and time-to-treatment remains prolonged. Prompt reperfusion treatment is essential to decrease mortality. The ACC/AHA guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation during percutaneous coronary intervention should be within ninety minutes of patient arrival to the ED or less and within 30 minutes for fibrinolytic therapy. However, few hospitals meet this objective. We did a retrospective analysis of patients with STEMI from January 2008 to December 2010. From an initial list of 57 patients, only 45 patients presented with confirmed STEMI. Of these, 35 had indication for reperfusion therapy. 97% received fibrinolytic therapy versus 3% who underwent percutaneous coronary intervention (PCI). The reperfusion time goal was achieved in 45% of cases treated with fibrinolytic therapy. Most of the patients presenting with STEMI undergo reperfusion therapy with fibrinolytic therapy. PCI was not performed as initial reperfusion therapy, even at regular duty hours. Reperfusion therapy was performed beyond the expected time goal in more that half of the cases. The most significant delay was related to nursing staff performance.
authors.affiliation: Internal Medicine Department, Ponce School of Medicine Health Sciences Center and Damas Hospital, Ponce, Puerto Rico. anabeauchamp875@hotmail.com
authors.forename: Ana
authors.initials: A
authors.lastname: Beauchamp-Irizarry
authors.forename: José
authors.initials: J
authors.lastname: Gómez-Rivera
authors.forename: Rafael
authors.initials: R
authors.lastname: Bredy Domínguez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D015425:Myocardial Reperfusion; D012189:Retrospective Studies