Journal article
Door-to-needle performance in African ST-elevation myocardial infarction management: A systematic review and meta-analysis
JRSM cardiovascular disease, Vol.14, pp.1-7
2025
DOI: 10.1177/20480040251396698
PMCID: PMC12605892
PMID: 41234305
Abstract
Timely fibrinolysis remains the cornerstone of reperfusion for ST-elevation myocardial infarction (STEMI) in settings without reliable access to primary percutaneous coronary intervention (PCI). International guidelines recommend a door-to-needle time (DTNT) of 30 min or less.
We conducted the first continent-wide meta-analysis to quantify real-world DTNTs and adherence to guideline benchmarks in African hospitals.
We systematically searched PubMed/MEDLINE, Scopus, and Web of Science through July 2, 2025, for studies reporting DTNT for adult STEMI patients treated with thrombolysis in Africa. Pooled mean DTNT was estimated via random-effects meta-analysis with restricted maximum likelihood and Knapp-Hartung adjustment. Heterogeneity was assessed by Cochran's
and
, and sensitivity analyses evaluated robustness.
Across 12 eligible studies encompassing a total of 2193 STEMI patients, about 1261 individuals (57.5%) received thrombolytic therapy. Among the 11 studies reporting mean reperfusion times (1011 patients), the overall pooled mean DTNT was 74.8 min (95% confidence interval: 44.4-105.2;
= 99.4%), substantially exceeding the recommended benchmark. Notably, only 36.3% of thrombolyzed patients achieved a DTNT of ≤30 min. Furthermore, none of the included study cohorts reported an overall mean DTNT within 30 min.
African STEMI patients experience door-to-needle delays more than twice the guideline target, with fewer than 4 in 10 receiving timely fibrinolysis. In such settings lacking widespread PCI, implementation of standardized reperfusion protocols, optimized in-hospital workflows, and targeted quality-improvement initiatives is urgently needed to accelerate fibrinolysis, maximize myocardial salvage, and reduce adverse cardiovascular outcomes.
Details
- Title: Subtitle
- Door-to-needle performance in African ST-elevation myocardial infarction management: A systematic review and meta-analysis
- Creators
- Carlson Sama - West Virginia UniversityEfeturi Okorigba - West Virginia University HospitalsSaim Rana - West Virginia University HospitalsBasel Abdelazeem - West Virginia University HospitalsHuzaifah Qureshi - West Virginia University HospitalsAdemola Ajibade - University of Iowa, Internal MedicineBinita Bhandari - West Virginia University HospitalsJason Moreland - West Virginia UniversityMohamad Al-Saed - West Virginia University HospitalsMeshal Alsulami - West Virginia University HospitalsCharoo Iyer - West Virginia University HospitalsPooja Warrier - West Virginia University HospitalsMuchi Ditah Chobufo - West Virginia UniversityBryan Raybuck - West Virginia University HospitalsSudarshan Balla - West Virginia University
- Resource Type
- Journal article
- Publication Details
- JRSM cardiovascular disease, Vol.14, pp.1-7
- DOI
- 10.1177/20480040251396698
- PMID
- 41234305
- PMCID
- PMC12605892
- NLM abbreviation
- JRSM Cardiovasc Dis
- ISSN
- 2048-0040
- eISSN
- 2048-0040
- Language
- English
- Electronic publication date
- 11/11/2025
- Date published
- 2025
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985033245602771
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