Factors Contributing to Delayed Presentation In ST-Elevation Myocardial Infarction and Implication for In-Patient Outcomes

Abstract

Introduction: ST-elevation myocardial infarction (STEMI) is a significant cause of mortality and morbidity among patients with ischemic heart disease. Early intervention, such as primary percutaneous coronary intervention (PPCI) or thrombolysis has been shown to improve patient outcomes. However, delayed presentation in STEMI results in larger infarct size and increased complications.Objectives: This retrospective descriptive study aimed to identify factors contributing to delayed presentation in STEMI and in-patient outcomes.Methodology: A retrospective descriptive study was conducted. All the STEMI patients who underwent primary percutaneous coronary intervention at National Hospital Kandy from February 2019 to December 2019 were studied.Results: A total of 243 STEMI patients who underwent PPCI at the National Hospital Kandy from February 2019 to December 2019 were studied. Among the study population, 31.27% were delayed presenters and 68.72% were non–delayed presenters. Atypical chest pain was identified as the main reason for a delayed presentation. Female gender was not associated with delayed presentation, contrary to the findings in other studies. Diabetes mellitus and the location of the culprit lesion did not significantly contribute to delayed presentation in this study group. Complications during hospital stay and average duration of hospital stay were not significantly different between delayed and non-delayed presenters. However, delayed presenters exhibited lower left ventricular ejection fraction on discharge, which is a critical predictor of short and long-term outcomes.Conclusions: Community awareness programs are essential to minimize pre-hospital delays in STEMI presentation. Early recognition of atypical symptoms, irrespective of gender, and timely intervention are vital for improving outcomes in STEMI patients. Further research is warranted to explore the impact of other risk factors and co-morbidities on the duration of presentation in STEMI patients.