Prevalence and causes of failure of receiving thrombolytic therapy in patients with acute ST-segment elevation myocardial infarction

BackgroundMissing thrombolytic therapy in patients with acute ST-elevation myocardial infarction (STEMI) can have dire consequences. We studied the prevalence and causes of failure of receiving thrombolytic therapy in patients with STEMI and its impact on the clinical outcome during hospitalization.Patients and methodsThis was an observational, analytic, cross sectional study carried out in the CCU and emergency departments of three public hospitals in Port Said, Egypt. We interrogated all patients admitted within 72 h of possible acute coronary syndrome and only patients proved to have STEMI as defined by the updated ACC criteria were analyzed for receiving thrombolytic therapy or not. All STEMI patients were subjected to: medical history taking, thorough clinical examination, 12-leads surface electrocardiography, cardiac biomarkers (troponin I), and predischarge trans-thoracic echocardiography.ResultsOf 6522 patients screened, only 288 patients had STEMI. The prevalence of missed thrombolysis in these patients was 45%. Delayed presentation after the onset of symptoms represented the most common cause for failure to receive thrombolysis (54% of the cases), while misdiagnosis at the emergency department represented 35% of the cases. Female gender, diabetes mellitus and inferior location of myocardial infarction were independent predictors of missed thrombolytic therapy. Cardiac death, clinical heart failure and significant cardiac dysrhythmias were higher in patients who missed thrombolysis than in those who received it.ConclusionIn this study, up to 45% of patients with STEMI missed the opportunity to receive thrombolysis, most likely due to delayed presentation or misdiagnosis at the emergency department. Patients with missed thrombolysis were at higher risk of cardiac death, clinical heart failure, and hemodynamically significant cardiac dysrhythmias.