Management Strategies for 300 Cases of ST-Elevated Myocardial Infarction in a Tertiary Hospital: Experience from Rural Community in Bangladesh

Abstract

Background: ST-Elevated Myocardial Infarction (STEMI) remains a critical cardiovascular emergency requiring prompt and effective intervention. Objective: This paper presented a comprehensive analysis of 300 STEMI cases managed at Khwaja Yunus Ali Medical College Hospital, a tertiary care center located in a rural region. Methodology: This retrospective study was conducted in the Department of Cardiology at Khwaja Yunus Ali Medical College Hospital, Bangladesh, including 300 consecutive adult patients (≥18 years) diagnosed with ST-elevation myocardial infarction (STEMI) between January 2022 and December 2024. STEMI diagnosis was based on clinical presentation, electrocardiographic changes, and elevated cardiac biomarkers. Data were collected from medical records using a structured form, including demographics, cardiovascular risk factors, clinical features, time to presentation, treatment modalities, and in-hospital outcomes. Patients were managed according to standard national and international guidelines, including initial stabilization, pharmacological therapy, and reperfusion strategies such as primary percutaneous coronary intervention (PCI) or thrombolysis depending on availability and timing. All patients were monitored in the coronary care unit for complications and supportive care. The primary outcome was in-hospital mortality, while secondary outcomes included major adverse cardiac events such as heart failure, arrhythmias, reinfarction, and cardiogenic shock. Results: Among the 300 STEMI patients, 68.0% were male and 32.0% female, with a mean age of 58 years. The most common risk factors were smoking (60.0%), hypertension (54.0%), diabetes mellitus (38.0%), and dyslipidemia (30.0%). The median time from symptom onset to hospital presentation was 6.5 hours, indicating significant pre-hospital delay. Regarding management, thrombolysis was the most frequently used reperfusion strategy (52.0%), followed by primary PCI (40.0%), while 8.0% received conservative treatment. The overall in-hospital mortality rate was 8.0%, with heart failure (14.0%), arrhythmias (10.0%), and reinfarction (3.0%) being the major complications. Conclusion: In this study, STEMI patients predominantly presented late with a high burden of cardiovascular risk factors, and while thrombolysis remained the most commonly used and life-saving reperfusion strategy in resource-limited settings, primary PCI was associated with better clinical outcomes, lower complication rates, and improved in-hospital prognosis. Journal of National Institute of Neurosciences Bangladesh, July 2025;11(2):126-131