Abstract:
The SA Heart Association seeks to to improve the early
management of ST-segment elevation myocardial
infarction in South Africa. This pilot study was undertaken
to establish the current time intervals present
in the referral pathways to percutaneous coronary
intervention (PCI) facilities in the Tshwane Metropole
and to further identify the barriers to appropriate
management of STEMI.
Method: Cardiologists from 5 PCI-capable hospitals
recruited the patients in the catheterisation laboratory
and captured the data. Interviews were conducted with
three emergency medical services (EMS) to assess
paramedics’ scope of practice and identify hindrances
to the effective management of STEMI patients.
Results: Median system delays were longer in patients
requiring inter-facility transport (IFT; n=29) compared
to patients with direct access to a PCI facility (DA)
patients (median 3.7 vs. 30.4 hours; p<0.001). Door-toballoon
times of ≤90 minutes were achieved in only 22%
DA and 33% IFT patients. Fibrinolysis within ≤30
minutes was achieved in 50% DA and 20% IFT patients.
Reperfusion was attempted in <12 hours of symptom onset in signifi cantly more DA than IFT patients (70%
vs. 34%; p=0.012 respectively). Paramedics were suitably
trained and ambulances reasonably equipped to manage
STEMI patients. However, members of the public do not
routinely summon EMS.
Conclusion: Education initiatives and improved systems
of care have the potential to improve STEMI patient
outcome in South-Africa.
