title: Management and outcomes of acute ST-segment-elevation myocardial infarction at a tertiary-care hospital in Sri Lanka: an observational study.
abstract: BACKGROUND
  Sri Lanka is a developing country with a high rate of cardiovascular mortality. It is still largely dependent on thrombolysis for primary management of acute myocardial infarction. The aim of this study was to present current data on the presentation, management, and outcomes of acute ST-segment-elevation myocardial infarction (STEMI) at a tertiary-care hospital in Sri Lanka.
  
  
  METHODS
  Eighty-one patients with acute STEMI presenting to a teaching hospital in Peradeniya, Sri Lanka, were included in this observational study.
  
  
  RESULTS
  Median interval between symptom onset and hospital presentation was 60 min (mean 212 min). Thrombolysis was performed in 73% of patients. The most common single reason for not performing thrombolysis was delayed presentation. Median door-to-needle time was 64 min (mean, 98 min). Only 16.9% of patients received thrombolysis within 30 min, and none underwent primary PCI. Over 98% of patients received aspirin, clopidogrel, and a statin on admission. Intravenous and oral beta blockers were rarely used. Follow-up data were available for 93.8% of patients at 1 year. One-year mortality rate was 12.3%. Coronary intervention was performed in only 7.3% of patients post infarction.
  
  
  CONCLUSIONS
  Late presentation to hospital remains a critical factor in thrombolysis of STEMI patients in Sri Lanka. Thrombolysis was not performed within 30 min of admission in the majority of patients. First-contact physicians should receive further training on effective thrombolysis, and there is an urgent need to explore the ways in which PCI and post-infarction interventions can be incorporated into treatment protocols.
authors.forename: Ruwanthi
authors.initials: R
authors.lastname: Bandara
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. arjuna.medagama@gmail.com.
authors.forename: Arjuna
authors.initials: A
authors.lastname: Medagama
authors.forename: Ruwan
authors.initials: R
authors.lastname: Munasinghe
authors.forename: Nandana
authors.initials: N
authors.lastname: Dinamithra
authors.forename: Amila
authors.initials: A
authors.lastname: Subasinghe
authors.forename: Jayantha
authors.initials: J
authors.lastname: Herath
authors.forename: Mahesh
authors.initials: M
authors.lastname: Ratnayake
authors.forename: Buddhini
authors.initials: B
authors.lastname: Imbulpitiya
authors.forename: Ameena
authors.initials: A
authors.lastname: Sulaiman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006760:Hospitalization; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors; D013188:Sri Lanka; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase