title: Current reperfusion strategies for ST-elevation myocardial infarction in an academic medical center in a developing country: efficacy of primary percutaneous coronary intervention.
abstract: OBJECTIVE
  To study the reperfusion strategies currently being used in the treatment of ST-elevation myocardial infarction (STEMI) at an academic medical center in a developing country and to analyze the door-to-balloon time (DBT) in those patients undergoing primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  The study included all patients presenting with STEMI to the emergency department at the American University of Beirut Medical Center between July 2008 and February 2010. Data were collected prospectively from the patients' medical records.
  
  
  RESULTS
  The study population consisted of 100 consecutive patients. Compared with an earlier study from American University of Beirut Medical Center done in 2002-2005, there was a significant increase in the utilization of primary PCI for reperfusion (81% vs. 2.5%; P < 0.001). However, the median DBT was 110 minutes, with only 30% of patients achieving a DBT ≤90 minutes. The predictors of delayed DBT (>90 minutes) were culprit lesions in the circumflex artery (P = 0.007) and delayed time from electrocardiogram to arrival in the catheterization laboratory (P < 0.001).
  
  
  CONCLUSIONS
  There was a significant increase in the utilization of primary PCI for reperfusion of STEMI in this academic medical center in a developing country. However, achieving a target DBT ≤90 minutes was suboptimal. Future studies are needed to analyze the logistic factors associated with delayed reperfusion to institute policies and systems that can enhance the efficacy of primary PCI as a reperfusion modality in these countries.
authors: Department of Internal Medicine, American University of Beirut, Lebanon.
authors: Ali
authors: A
authors: Rabah
authors: Katia
authors: K
authors: El-Sibai
authors: Abeer
authors: A
authors: Dakik
authors: Salam
authors: S
authors: Itani
authors: Habib A
authors: HA
authors: Dakik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007861:Lebanon; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data; D061646:Operative Time; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D011446:Prospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome