Abstract
Introduction: Cardiovascular disease remains the main cause of death in the world, and myocardial infarction represents the main contributor to this mortality. Timely restoration of myocardial blood flow with reperfusion therapy is crucial. Pre-hospital delay is a major obstacle for early reperfusion therapy and has negative impact on mortality and left ventricle function.
 Methods: A prospective study was carried in cardiology unit of a medical college from August 2013 to December 2017. Cases of acute ST segment elevation myocardial infarction that have undergone thrombolysis were recruited.
 Results: Out of 450 patients with ST Elevation Myocardial Infection (STEMI), delayed presentation was seen in 288 (64%) for >6 hrs and 108 (24%) patients for >12 hrs. The duration from onset of symptoms to the presentation in the emergency room (pre-hospital delay) was 12.66 hrs (SD=14.19, range = 30 min to 72 hrs). The door to needle time was 54 min (SD=24) The major factors for pre-hospital delay were misinterpretation of symptoms (59%) and transportation problems (31%).
 Conclusion: Misinterpretation of symptoms remain the most common cause of delayed presentation. Health education for public awareness can reduce the delay. Extension of thrombolytic therapy to district hospital and primary health center level after basic training for medical officer with checklist and collaboration in form of telemedicine with referral cardiac center may have major impact on morbidity and mortality reduction in acute STEMI patients with early reperfusion therapy.
Highlights
Cardiovascular disease remains the main cause of death worldwide, and myocardial infarction represents the main contributor to this mortality
The diagnosis of ST Elevation Myocardial Infection (STEMI) was done based on 2013 ACC/AHA guideline and thrombolytic agents were given according to patient party preference after they were given the option of both Streptokinase (STK) and Tenecteplase (TNK)
Thromboytic agents were given in patients presented within 12 of chest pain or had clinical or electrocardiographic evidence of ongoing ischemia when given beyond 12 hrs
Summary
Cardiovascular disease remains the main cause of death in the world, and myocardial infarction represents the main contributor to this mortality. Pre-hospital delay is a major obstacle for early reperfusion therapy and has negative impact on mortality and left ventricle function. Extension of thrombolytic therapy to district hospital and primary health center level after basic training for medical officer with checklist and collaboration in form of telemedicine with referral cardiac center may have major impact on morbidity and mortality reduction in acute STEMI patients with early reperfusion therapy. "48% of NCDs deaths in lowand middle-income countries in 2015 occurred before the age of 70".[1] Cardiovascular disease remains the main cause of death worldwide, and myocardial infarction represents the main contributor to this mortality. A landmark study by De Luca et al showed that every 30 minutes
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