Factors Associated with Delayed Thrombolytic Medication among Patients with ST-Segment Elevation Myocardial Infarction in Southern Thailand

Background: ST-Segment Elevation Myocardial Infarction (STEMI) is among the most prevalent heart diseases worldwide and a leading cause of death. Delayed thrombolytic treatment significantly increases mortality risk in affected patients. This study aimed to identify factors associated with delayed administration of thrombolytic medication in STEMI patients. Methods: A cross-sectional analytical study was conducted in Narathiwat Province, involving 1,074 STEMI patients documented in the Acute Coronary Syndrome Registry between January 1, 2016, and December 31, 2021. Of these, 781 eligible patients were categorized into two groups: 464 with delayed thrombolytic medication and 317 without. Descriptive statistics and multiple logistic regression used for data analysis. Results: The proportion of patients experiencing delayed thrombolytic medication was 59.4% (95% CI: 55.8-62.9). Factors such as the total number of underlying diseases, Killip classification, and timing of accessing health services were associated with delayed thrombolytic medication. Patients with four underlying diseases had a reduced risk of delayed thrombolytic medication (AOR = 0.40, 95% CI: 0.24-0.63). Conversely, those diagnosed with cardiogenic shock (Class IV) (AOR = 3.74, 95% CI: 1.94-7.20) and those accessing services at night increased risk of delayed thrombolytic mediation (AOR = 2.16, 95% CI: 1.37-3.40). Conclusion: The number of underlying diseases, Killip classification, and timing of health service access were linked to delayed thrombolytic medication. STEMI patients with advanced Killip classification, particularly those seeking care at night, should receive intensified attention to ensure timely administration of thrombolytic, thereby mitigating disease progression and reducing mortality. Keywords: Delayed Thrombolytic Medication, ST-elevation myocardial infarction, Thrombolytic therapy, Thailand