DOI: http://dx.doi.org/10.18203/2349-3933.ijam20193257

Efficacy of thrombolytic therapy with IV streptokinase in acute ST elevation myocardial infarction patients

Karthik S., Satchi A. Surendran, Mohamed Kasim A.

Abstract


Background: Acute Myocardial Infarction is one of the leading causes of mortality and morbidity. Now there are a number of drugs for Thrombolysis but still Streptokinase is used in many of the centers because of the ease of availability and less cost. ST segment elevation resolution following thrombolysis is simple, non-invasive, accessible tool for the assessment of coronary reperfusion. Objective of the present study was to assess the efficacy of thrombolysis in Acute STEMI patients, with respect to resolution of ST-elevation on treatment with streptokinase and also to predict short term outcome during hospital stay in terms of adverse events and mortality.

Methods: 60 Acute STEMI patients who had received thrombolytic therapy with streptokinase were studied in three groups namely Category A, Category B and Category C based on ST segment resolution after administration of thrombolytic therapy.

Results: Of 60 patients, 9 patients (15%) had <30% ST resolution (no STR), 26 patients (43.3%) had 30-70% ST resolution (partial STR), 25 patients (41.7%) had >70% ST resolution (complete STR).

Conclusions: In the present study we conclude that the efficacy of IV streptokinase for thrombolysis in acute STEMI is 41.7%. Patients with no resolution of ST segment 90 minutes following thrombolysis associated with more frequent adverse events and increased mortality compare to partial and complete resolution group.


Keywords


Acute myocardial infarction; ST segment resolution and thrombolysis

Full Text:

PDF

References


Chia BL, Yip JW, Tan HC, Lim YT. Usefulness of ST elevation II/III ratio and ST deviation in lead I for identifying the culprit artery in inferior wall acute myocardial infarction. Am J Cardiol. 2000;86(3):341-3.

The IS. SAM Study Group. A prospective trial of intravenous streptokinase in acute myocardial infarction (ISAM): mortality, morbidity, and infarct size at 21 days. N Engl J Med. 1986;314:1465-71.

Eric J topol, Robert M Califf MD, Michel Vanderwal HD. A randomized trial of late reperfusion therapy for acute myocardial infarction. Circulation. 1992;185:6.

Kennedy JW, Ritchie JL, Davis KB, Fritz JK. Western Washington randomized trial of intracoronary streptokinase in acute myocardial infarction. New Eng J Med. 1983;309(24):1477-82.

Sezer M, Nisanci Y, Umman B, Yilmaz E, Olcay A, Erzengin F, et al. New support for clarifying the relation between ST segment resolution and microvascular function: degree of ST segment resolution correlates with the pressure derived collateral flow index. Heart. 2004;90(2):146-50.

Schröder K, Wegscheider K, Zeymer U, Tebbe U, Schröder R. Extent of ST-segment deviation in a single electrocardiogram lead 90 min after thrombolysis as a predictor of medium-term mortality in acute myocardial infarction. The Lancet. 2001;358(9292):1479-86.

French JK, Andrews J, Manda SO, Stewart RA, McTigue JJ, White HD. Early ST-segment recovery, infarct artery blood flow, and long-term outcome after acute myocardial infarction. Am heart J. 2002;143(2):265-71.

Dong J, Ndrepepa G, Schmitt C, Mehilli J, Schmieder S, Schwaiger M, et al. Early resolution of ST-segment elevation correlates with myocardial salvage assessed by Tc-99m sestamibi scintigraphy in patients with acute myocardial infarction after mechanical or thrombolytic reperfusion therapy. Circulat. 2002;105(25):2946-9.

Zeymer U, Schröder R, Tebbe U, Molhoek GP, Wegscheider K, Neuhaus KL. Non-invasive detection of early infarct vessel patency by resolution of ST-segment elevation in patients with thrombolysis for acute myocardial infarction. Results of the angiographic sub study of the Hirudin for Improvement of Thrombolysis (HIT)-4 trial. Euro Heart J. 2001;22(9):769-75.

Bhatia L, Clesham GJ, Turner DR. Clinical implications of ST-segment non-resolution after thrombolysis for myocardial infarction. J Royal Soc Med. 2004;97(12):566-70.

Anderson JL, Marshall HW, Bray BE, Lutz JR, Frederick PR, Yanowitz FG, et al. A randomized trial of intracoronary streptokinase in the treatment of acute myocardial infarction. New Eng J Med. 1983;308(22):1312-8.