Efficacy of STEMI Fast Track Management System
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Abstract
Background: ST elevation Ml (STEMI) is the high mortality rate condition. The key management is initiate reperfusion therapy as fast as possible. In rural hospital, thrombolytic drug is the only choice of reperfusion treatment and door to needle time is an indicator of effective fast track management system.
Objective: To compare door to needle time between pre and post applying the fast track management system.
Setting: Buriram hospital
Methods: This study is quasi-experimental study. The data were collected from prospective STEMI registry of all STEMI patients in Buriram hospital. All patient were divided into two group, pre and post applying the fast track management system. First group (n=31), pre applying the fast track management system, was collected data between October 1 2010 and September 30, 2011. Second group (n=44), post applying fast track management system, was collected data between October 1 2011 and September 30, 2012. Primary end point is door to needle time. Secondary end points are total ischemic time, in-hospital complication and mortality rate. The median of door to needle time and total ischemic time were compared by Mann-Whitney U test. In-hospital complication and mortality rate were compared by chi square or Fisher’s exact test.
Results: No difference in baseline characteristics, risk factors and disease severity between pre and post applying fast track system. Median of door to needle time was decreased after applying the fast track system (50 vs. 25 minutes; p<0.001). Percent of STEMI patients who achieve door to needle time within 30 min were improve (19.4% vs. 65.9%; p<0.001). Median of total ischemic time, in-hospital complications and mortality rate were not different.
Conclusion: Applying STEMI fast track improved door to needle time. However, short door to needle time was not enough to improve total ischemic time and mortality rate.
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References
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