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Door-to-needle performance in African ST-elevation myocardial infarction management: A systematic review and meta-analysis.

Carlson Sama, Efeturi Okorigba, Saim Rana, Basel Abdelazeem, Huzaifah Qureshi, Ademola Ajibade, Binita Bhandari, Jason Moreland, Mohamad Al-Saed, Meshal Alsulami and 5 more

JRSM cardiovascular disease · 2025-01-01 · Meta-analysis

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Abstract

BACKGROUND: 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. AIM: We conducted the first continent-wide meta-analysis to quantify real-world DTNTs and adherence to guideline benchmarks in African hospitals. METHODS: 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 Q and I 2, and sensitivity analyses evaluated robustness. RESULTS: 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; I 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. CONCLUSION: 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.

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Tags

Antithrombotics & thrombolytics · Time intervals · Thrombolytics · Implementation · Low- and middle-income settings

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