COMPARATIVE ANALYSIS OF TYPE OF MYOCARDIAL INFARCTION IN PATIENTS WITH SUCCESSFUL OR UNSUCCESSFUL STREPTOKINASE THROMBOLYSIS FOLLOWING ST ELEVATION MYOCARDIAL INFARCTION
Abstract
Objective: To study the effect of thrombolytic therapy in term of success and failure on the type of STelevation MI, using streptokinase. Material and Methods: This was a comparative study, conducted atDepartment of Cardiology, Lady Reading Hospital, Peshawar, from October 2006 to October 2007.Patients with first acute myocardial infarction were divided into group A (successful thrombolysis) andgroup B (unsuccessful thrombolysis) using ECG criteria. Results: Total number of patients were 200.Group A included 136 (68%) patients and group B included 64 (32%) patients. There were total 88(44%) patients of anterior MI with 47 patients in group A and 41 patients in group B (34.6% vs 64.0%,p<0.001). There were total 110 (55.0%) patients of inferior MI with 88 patients in group A and 22patients in group B (64.7% vs 34.4%, p<0.001). Lateral myocardial infarction was diagnosed in 2 (1%)patients with 1 patient each in group A and group B (0.7% vs 1.6%, p=0.583). Conclusion: AnteriorMI was associated with a higher rate of thromblysis failure while inferior MI and lateral wall MI wasassociated with a higher rate of successful thrombolysis.Keywords: Myocardial infarction; thrombolysis; type of myocardial infarctionReferences
Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto
Miocardico (GISSI). Effectiveness of intravenous thrombolytic
treatment in acute myocardial infarction. Lancet 1986;1:397–402.
ISIS-2 (Second International Study of Infarct Survival)
Collaborative Group. Randomised trial of intravenous
streptokinase, oral aspirin, both, or neither among 17,187 cases of
J Ayub Med Coll Abbottabad 2012;24(1)
http://www.ayubmed.edu.pk/JAMC/24-1/Sher.pdf
suspected acute myocardial infarction: ISIS-2. Lancet
;ii:349–60.
De Belder MA. Coronary disease: acute myocardial infarction:
unsuccessful thrombolysis. Heart 2001;85:104–12.
Group FTTFC. Indications for fibrinolytic therapy in suspected
acute myocardial infarction: collaborative overview of early
mortality and major morbidity results from all randomised trials
of more than 1,000 patients. Lancet 1994;343:311–22.
Sutton AG, Campbell PG, Price DJ. Failure of thrombolysis by
streptokinase: detection with a simple electrocardiographic
method. Heart 2000;84:149–56.
Ahmad S, Qureshi MBA, Abbas MZ, Chaudhry MK, Ghani
MU. A comparative study of complications in patients of
myocardial infarction managed with and without streptokinase.
Pak J Cardiol 2004;15:61–7.
Topol EJ. Acute myocardial infarction:thrombolysis. A current
overview of the benefits and limitations of thrombolytic strategies
and the move towards combining thrombolytic agents with
glycoprotein IIb/IIIa receptor blockers. Heart 2000;83:122–6.
Hochman JS, Sleeper LA, White HD. One-year survival following
early revascularization for cardiogenic shock. JAMA
;285:190–2.
Bhatia L, Clesham GJ, Turner DR. Clinical implications of STsegment non-resolution after thrombolysis for myocardial
infarction. J R Soc Med 2004;97:566–70.
Henriques JPS, Zijlstra F, Van’t Hof AW. Primary percutaneous
coronary intervention versus thrombolytic treatment: long term
follow up according to infarct location. Heart 2006;92:75–9.
Prendergast BD, Shandall A, Buchalter MB. What do we do
when thrombolysis fails? A United Kingdom survey. Int J
Cardiol 1997;61:39–42.
An international randomized trial comparing four thrombolytic
strategies for acute myocardial infarction. The GUSTO
investigators. N Eng J Med 1993;329:673–82.
Lee YY, Tee MH, Zurkurnai Y, Than W, Sapawi M, Suhairi I.
Thrombolytic failure with streptokinase in acute myocardial
infarction using electrocardiogram criteria. Singapore Med J
;49:304–10.
Goldhammer E, Kharash L, Abinader EG. Circadian fluctuations
in the efficacy of thrombolysis with streptokinase. Postgrad Med
J 1999;75:667–71.
Brener SJ, Ellis SG, Sapp SK. Predictors of death and
reinfarction at 30 days after primary angioplasty: the GUSTO IIb
and RAPPORT trials. Am Heart J 2000;139:476–81.
Schröder R, Wegscheider K, Schröder K, Dissmann R, MeyerSabellek W. Extent of early ST segment elevation resolution: a
strong predictor of outcome in patients with acute myocardial
infarction and a sensitive measure to compare thrombolytic
regimens. A substudy of the International Joint Efficacy
Comparison of Thrombolytics (INJECT) trial. J Am Coll Cardiol
;26:1657–64.
Schroder R, Zeymer U, Wegscheider K, Neuhaus KL, for the
HIT-4 Trial Group. A substudy of the Hirudin for Improvement
of Thrombolysis (HIT)-4 Study. Comparison of the predictive
value of ST segment elevation resolution at 90 and 180 min after
start of streptokinase in acute myocardial infarction. Eur Heart J
;20:1563–71
