Predictors of myocardial reperfusion in patients with ST-elevation myocardial infarction following thrombolytic treatment in rural community

Abstract

This cross-sectional study aims to examine patient and hospital factors contributing to reperfusion following thrombolysis in patients with ST- segment elevation myocardial infarction (STEMI) in rural hospitals in Thailand. Access to reperfusion therapy for STEMI patients in rural areas is increasing in Thailand, yet clinical outcomes vary between settings and are inferior to recommended guidelines. Ten years after the introduction of thrombolytic treatment for rural patients undergoing STEMI, there is still a limited description of factors influencing the outcomes of thrombolytic treatment. Data were collected from 87 acute STEMI patients who had received thrombolytic treatment in 12 thrombolysis-capable hospitals located in rural areas. Demographic and clinical characteristics included patient response and treatment seeking behavior, witness response to the patient symptoms, waiting time for treatment, severity of illness, guideline adherence and thrombolytic reperfusion. The results were: only 31 of 87 patients (35.63 %) received thrombolytic treatment within 30 minutes after arrival the hospital. A total of 42 patients (48.28%) had successful myocardial reperfusion following thrombolytic treatment. Logistic regression analysis revealed that guideline adherence (OR : 1.744 ; 95 % CI : 1.125 - 2.331), severity of illness (OR : .795 ; 95 % CI : .641 - .947), patient response and treatment seeking behavior (OR : 1.415 ; 95 % CI : 1.003 - 1.988) were predictors of thrombolytic reperfusion. In rural areas, healthcare resources and transfer facilities are limited. Therefore, the number of thrombolysis-capable hospitals should be increased and clinical practice guidelines and consideration of pre-hospital factors should be promoted. The role of nurses is critically important in improving access.