DOOR TO NEEDLE TIME OF STREPTOKINASE AND ST SEGMENT RESOLUTION ASSESSING THE EFFICACY OF REPERFUSION THERAPY AT KARACHI INSTITUTE OF HEART DISEASES

Authors

  • Riffat Sultana
  • Nuzhat Sultana
  • Abdul Rasheed
  • Zahid Rasheed
  • Mansoor Ahmed
  • Muhammad Ishaq
  • Abdus Samad

Abstract

Background: Early start of treatment including coronary revascularisation has been recognised ascrucial variable in the outcome of acute ST-segment Elevation Myocardial Infarction (STEMI).Objectives of the study were to determine the magnitude of ST-segment resolution after thrombolytictherapy predicts short- and long-term outcomes in patients with an Acute Myocardial Infarction (AMI).Methods: The duration of quasi experimental study was 3 years, from July 2006 to June 2009,conducted at Karachi Institute of Heart Diseases. Total 1,023 patients of STEMI treated withstreptokinase (SK) were enrolled in the study. Result: Of the total 1023, 689 (67.3%) patients weremales and 334 (32.6%) were females. Six hundred and twenty-nine (61.5%) were successfully resolvedafter thrombolytic therapy while in 395 (38.5%) patients ST-segment could not resolve into 3conventional ST-segment resolution categories at 60 minute and 90 minute after thrombolysis. Threehundred and twelve (30%) and 444 (43.4%) with complete resolution, 344 (33.62%) and 325 (31.76%)with partial resolution, 367 (35.8%) and 491 (19.29%) were with no resolution at 60 and 90 minutesrespectively. Conclusion: Shock, congestive heart failure, and recurrent angina and ischemia occurredmore often in patientswith partial or no ST resolution as compare to complete resolution.Keywords: myocardial infarction, thrombolysis, ST-segment elevation, congestive heart failure

References

Schröder K, Zeymer U, Wegschneider K, Schroder R. Prediction

of outcome in ST elevation myocardial infarction by the extent of

ST segment deviation recovery. Which method is best? [in

German] Z Kardiol 2004;93:595–604.

Nable JV, Brady W. The evolution of electrocardiographic changes

in ST-segment elevation myocardial infarction. Am J Emerg Med

;27:734–46.

Harkness JR, Sabatine MS, Braunwald E, Morrow DA, Sloan S,

Wiviott SD, et al. Extent of ST-segment resolution after

fibrinolysis adds improved risk stratification to clinical risk score

for ST-segment elevation myocardial infarction. Am Heart J

;59(1):55–62.

De Lemos JA, Braunwald E. ST segment resolution as a tool for

assessing the efficacy of reperfusion therapy. J Am Coll Cardiol

;38:1283–94.

Testa L, van Gaal WJ, Biondi-Zoccai GG, Abbate A, Agostoni P,

Bhindi R, et al. Repeat thrombolysis or conservative therapy vs.

rescue percutaneous coronary intervention for failed thrombolysis:

systematic review and meta-analysi QJM 2008;101:387–95.

Bata I, Armstrong PW, Westerhout CM, Travers A, Sookram S,

Caine E, et al. WEST Study Group. Time from first medical

contact to reperfusion in ST elevation myocardial infarction: a

Which Early ST Elevation Myocardial Infarction Therapy (WEST)

substudy. Can J Cardiol 2009;25:463–8.

Pereira JL, Sakae TM, Machado MC, Castro CM.TIMI risk score

for acute myocardial infarction according to prognostic

stratification. Arq Bras Cardiol 2009;93(2):105–12.

De Lemos JA, Antman EM, Giugliano RP, Morrow DA, McCabe

CH, Cutler SS, et al. Comparison of a 60 vs 90 minute

determination of ST-segment resolution after thrombolytic therapy.

J Am Coll Cardiol 2000;86:1235–7.

Lachance P, Déry JP, Beaudoin J, Barbeau GE, Noël B, Bertrand

OF, et al. ECG-guided immediate intervention at the time of

primary PCI to reduce door-to-balloon time in ST-elevation

myocardial infarction patients. J Invasive Cardiol 2008;20:623–6.

Parmley WW. Cost-effectiveness of reperfusion strategies. Am

Heart J 1999;138(2 Pt 2):S142–52.

Topol EJ, Ohman EM, Armstrong PW, Wilcox R, Skene AM,

Aylward P, et al. Survival outcomes 1 year after reperfusion

therapy with either alteplase or reteplase for acute myocardial

infarction: results from the Global Utilization of Streptokinase and

t-PA for Occluded Coronary Arteries (GUSTO) III Trial.

Circulation 2000;102:1761–5.

Banerjee A, Chisti Y, Banerjee UC. Streptokinase--a clinically

useful thrombolytic agent. Biotechnol Adv 2004;22:287–307.

Kauffmann QR. Timing is crucial in acute myocardial infarction.

Rev Med Chil 2008;136:1095–7.

Suri A, Ahsan S, Lim J, Cusack TP, Chua TP, Leatham EW. Early

administration of thrombolysis can prevent myocardial necrosis:

time is myocardium. Emerg Med J 2009;26:541–2.

Danchin N. Systems of care for ST-segment elevation myocardial

infarction: impact of different models on clinical outcomes. JACC

Cardiovasc Interv 2009;2:901–8.

Kostić T, Perisić Z, Milić D, Apostolović S, Martinović SS,

Bozinović N, et al. Coronary flow and hemorrhagic complications

after alteplase and streptokinase administration in patients with

acute myocardial infarction. Vojnosanit Pregl 2009;66:218–22.

Giraldez RR, Wiviott SD, Nicolau JC, Mohanavelu S, Morrow

DA, Antman EM, et al. Streptokinase and enoxaparin as an

alternative to fibrin-specific lytic-based regimens: an ExTRACTTIMI 25 analysis. Drugs 2009;69:1433–43.

Geltman EM. Coronary thrombolysis with intravenous

streptokinase. Cardiol Clin 1987;5(1):91–9.

Tatu-Chiţoiu G, Teodorescu C, Dan M, Guran M, Căpraru P,

Istrăţescu O, et al. Streptokinase-induced hypotension has no

detrimental effect on patients with thrombolytic treatment for acute

myocardial infarction. A substudy of the Romanian Study for

Accelerated Streptokinase in Acute Myocardial Infarction (ASKROMANIA). Rom J Intern Med 2004;42:557–73.

Brueck M, Bandorski D, Kramer W, Vogt PR, Heidt MC. The late

open infarct-related artery hypothesis: evidence-based medicine or

not? Clin Cardiol 2007;30:541–5.

Centurión OA. The open artery hypothesis: beneficial effects and

long-term prognostic importance of patency of the infarct-related

coronary artery. Angiology 2007;58:34–44.

Jensen-Urstad M, Samad BA, Jensen-Urstad K, Hulting J, Ruiz H,

Bouvier F, et al. Risk assessment in patients with acute myocardial

infarction treated with thrombolytic therapy. J Intern Med

;249:527–37.

Koren G, Weiss AT, Hasin Y, Appelbaum D, Welber S,

Rozenman Y, et al. Prevention of myocardial damage in acute

myocardial ischemia by early treatment with intravenous

streptokinase. N Engl J Med 1985;313:1384–9.

Purcell IF, Newall N, Farrer M. Change in ST segment elevation

minutes after thrombolytic initiation predicts clinical outcome as

accurately as later electrocardiographic changes. Heart

;78:465–71.

Busk M, Maeng M, Rasmussen K, Kelbaek H, Thayssen P,

Abildgaard U, et al. The Danish multicentre randomized study of

fibrinolytic therapy vs. primary angioplasty in acute myocardial

infarction outcome after 3 years follow-up. Eur Heart J

;29:1259–66

Published

2010-03-01

Most read articles by the same author(s)

1 2 > >>