Délais de thrombolyse chez les patients en infarctus du myocarde dans un centre hospitalier de Chaudière-Appalaches

Authors: Maire, Sébastien
Advisor: Dionne, ClermontLortie, Gilles
Abstract: BACKGROUND : The sooner a patient with an acute myocardial infarction receives a thrombolytic treatment, the better the outcome in terms of morbidity and mortality. Some delay exists, however, between the onset of the first symptoms and the start of the thrombolytic regimen. OBJECTIVES : 1) To describe the sociodemographic characteristics and cardiovascular risk factors of a population of patients brought in by ambulance to Hôtel-Dieu de Lévis hospital with a diagnosis of acute myocardial infarction (AMI) between January 2001 and August 2003; 2) To determine “call-to-needle” time, “hospital” time and “prehospital” time in the population under study; 3) To identify the variables associated with delays in thrombolysis. METHODS : This was a retrospective analysis of 82 hospital and emergency medical services (EMS) records from January 2001 to August 2003. Records were gathered from a data bank created for the emergency department of Hôtel-Dieu de Lévis hospital. Patients were included if they were older than 18 years, were not pregnant, had not been transferred from another hospital, came by ambulance and had received a thrombolytic regimen for acute myocardial infarction with ST elevation on their initial EKG. Dependent variables included times of symptoms onset, EMS call, EMS arrival and departure from patient’s residence, EMS arrival at the hospital, nurse triage, doctor evaluation and treatment. Independent variables included the presence of diabetes, cardiac disease history, hypertension, smoking, hypercholesterolemia, age, sex, type of AMI, distance residence-hospital, vital signs at arrival and other treatments received besides thrombolysis. Descriptive analyses were performed mainly for cardiovascular risk factors and sociodemographics characteristics. Bivariate analyses were then conducted between these variables and “call-to-needle” times, “hospital” times and “prehospital” times. Data were then processed in a mutivariate analysis model, mainly to adjust for confounding factors. RESULTS : Sixty-six percent of the study population were males aged of 64 years (as a mean). The most frequent cardiac risk factors were myocardial infarction, angina, tobacco use, family history of coronary artery disease or diabetes mellitus. As far as 16 % of patients had an altered state at presentation (shock, altered mental status and/or heart failure). A majority of patients (57 %) had an inferior myocardial infarction. Most of them (50 %) presented themselves during the day. The majority of patients had normal vital signs, but twelve percent presented complications (mainly angina, hypotension, arythmia and/or death). Prehospital delay was 38 minutes. Hospital delay was 30 minutes. Call-to-needle time was 68 minutes. Two sub-populations were identified: one living near the hospital and one living far from it. For the sub-population living far from the hospital, the distance residence-hospital was identified, after adjustements, as a signifiant determinant of “call-to-needle” time and “prehospital” time, as were also dislipidemia for “prehospital” time and a defavorised social rating for “hospital” time. As for the sub-population living near the hospital, the distance residence-hospital was a significant determinant of “hospital” time after adjustements. CONCLUSION : The “golden hour” recommendation was not respected in our study population by an average of eight minutes. Hospital delay, particularly with respect to treatment, seems to be the portion most amenable to change.
Document Type: Mémoire de maîtrise
Issue Date: 2005
Open Access Date: 11 April 2018
Permalink: http://hdl.handle.net/20.500.11794/18080
Grantor: Université Laval
Collection:Thèses et mémoires

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