Management of acute coronary syndromes with ST segment elevation (STEMI) is a race again time: time is myocardium». Treatment consist in reperfusion strategy by coronary intervention or thrombolysis. The main objective of this work was to evaluate the time delays of treatment and the extending factors during STEMI.

It was a prospective, descriptive and analytic study on 6 months including all patients admitted for STEMI. We studied the time delays and the extending factors.

We included 50patients. The average age was 58,4years and the sex ratio M/F was 2,5. Chest pain was typical for 39patients. Mean time delay between pain onset and first medical contact was 12h16min. The first medical contact was a general physician for 33 patients and a cardiologist for 8 patients. The average time delay between the first medical contact and an electrocardiogram was 9h57min. The main factor of late diagnosis were unavailability of electrocardiograph and absence of prescription of an electrocardiogram. The average time delay between the diagnosis electrocardiogram and admission in cardiology department was 3h02min. The transport was the main extending factor. Aspirin and clopidogrel were used respectively for 17 and 10patients. Among the patients admitted directly in cardiology, the average time delay for a diagnostic electrocardiogram was 30min. Thrombolysis was performed in 17patients within an average delay of 2h11min. A rupture of streptokinase was the most common extending factor. Twenty-three patients underwent percutaneous coronary intervention with a main time delay between diagnostic electrocardiogram and cath lab of 2h42min. The unavailability of medical team was the first extending factor.

Factors related to long delay in admission and care are a proof of lack of codified management of STEMI. It is necessary to develop the prehospital emergency medicine, educate population and medical staff.