title: Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study.
abstract: BACKGROUND
  Delayed reperfusion is associated with worse outcomes in ST-segment elevation myocardial infarction (STEMI). This study was conducted to assess the components and determinants of therapeutic delay in STEMI patients of our state.
  
  
  METHODS
  This study included consecutive patients of STEMI admitted to the coronary care units of two tertiary care hospitals in Srinagar, between 2012 and 2015. Various components of treatment delay including the patient's decision to delay, referral delay, transportation delay, prehospital delay, and door-to-needle time were calculated. Factors associated with delayed treatment and clinico-demographic correlates of late presentation were identified.
  
  
  RESULTS
  During a period of 3 years, 523 patients (mean age, 57.6 ± 10.5 years) were enrolled in this study. Thrombolysis was administered to 60.2% patients, while 39.8% of patients could not be thrombolysed because of late presentation. The median treatment delay was 250 minutes. Prehospital delay constituted about 83.8% of total treatment delay. Patient's decision to delay, referral delay, and transport delay constituted 59%, 16%, and 25% of prehospital delay, respectively. Median door-to-needle time was 40 minutes. Residence in rural areas [odds ratio (OR), 2.35; 95% confidence interval (CI), 1.60-3.46], absence of priorcoronary artery disease(OR, 1.54; 95% CI, 1.00-2.39), and negative family history ofcoronary artery disease(OR; 2.76; 95% CI, 1.86-4.10), were identified as independent predictors of delayed presentation (p< 0.001). Interestingly, 44.7% of the patients presented late due to misdiagnosis by local healthcare providers.
  
  
  CONCLUSIONS
  The standard of STEMI management in our state is far from ideal, and calls for a lot of improvement. Major efforts to reduce prehospital and in-hospital treatment delays are urgently needed.
authors.affiliation: Dept. of Cardiology, SKIMS, Srinagar, aIndia.
authors.forename: Jahangir Rashid
authors.initials: JR
authors.lastname: Beig
authors.affiliation: Dept. of Cardiology, SKIMS, Srinagar, aIndia.
authors.forename: Nisar A
authors.initials: NA
authors.lastname: Tramboo
authors.affiliation: Dept. of Medicine, SKIMS, Srinagar, bIndia.
authors.forename: Kuldeep
authors.initials: K
authors.lastname: Kumar
authors.affiliation: Dept. of Cardiology, SKIMS, Srinagar, aIndia.
authors.forename: Irfan
authors.initials: I
authors.lastname: Yaqoob
authors.affiliation: Dept. of Cardiology, SKIMS, Srinagar, aIndia.
authors.forename: Imran
authors.initials: I
authors.lastname: Hafeez
authors.affiliation: Dept. of Cardiology, SKIMS, Srinagar, aIndia.
authors.forename: Fayaz A
authors.initials: FA
authors.lastname: Rather
authors.affiliation: Dept. of Cardiology, SKIMS, Srinagar, aIndia.
authors.forename: Tariq R
authors.initials: TR
authors.lastname: Shah
authors.affiliation: Dept. of Cardiology, SKIMS, Srinagar, aIndia.
authors.forename: Hilal A
authors.initials: HA
authors.lastname: Rather
keywords: Coronary artery disease; Late presentation; Prehospital delay; ST-elevation myocardial infarction; Treatment delay