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Background: Atherosclerotic coronary artery disease particularly myocardial infarction is the leading cause of morbidity and mortality all over the world and its incidence is also on the rise in Pakistan. This study was done to assess the effectiveness of thrombolytic therapy in patients with acute myocardial infarction and comparison between diabetics and non- diabetics.Methods: This cross sectional study was conducted at Department of Cardiology, Bahawal Victoria Hospital, Bahawalpur from January to June 2019. Total 380 patients of aged 30-70 years either male or female with diagnosis of acute ST-elevation myocardial infarction presenting within 12 hours of the onset of chest pain were selected. Patients were given thrombolytic therapy with Streptokinase 1.5 MIU over 1 hour and post therapy, efficacy was assessed.Results: Mean age of the patients was 51.37±10.08 years. Mean duration of diabetes mellitus was 5.99±3.47 years. Duration of chest pain ranged from 1 hour to 12 hours with mean duration of 4.66±2.98 hours. Out of 380 patients of MI, treatment was found effective in 202 (53.2%) patients. Female gender, type of MI, and duration of chest pain were significantly associated with reduced efficacy (p value < 0.05). Presence of hypertension, smoking, dyslipidemia or family history of MI did not alter the efficacy significantly (p>0.05) while patients having diabetes had significantly reduced efficacy (p value < 0.001).Conclusions: There is reduced effectiveness of thrombolytic therapy in diabetic patients with ST elevation myocardial infarction.
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Introduction: Coronary heart disease (CHD) is a major causeof mortality and morbidity all over the world. This study wasundertaken to assess the resolution of ST segment at 90 min ofthrombolysis in STsegment elevation myocardial infarction asa predictor of short term outcome in terms of adverse eventsand mortality during hospital stay.Material and methods: A total of 100 patients with firstepisode of ST elevation myocardial infarction without anyconventional contraindication for thrombolysis were takenfor the study. % of ST segment resolution after 90 minof thrombolysis was calculated and correlation with vitalparameters like Killip class, ejection fraction, incidence ofarrhythmias, prognosis in the patients with acute MyocardialInfarction.Results: Out of 100 patients who were thrombolysed, 30%had failed thrombolysis. Patient who presented within 6hours of chest pain had 7.7% failed thrombolysis which wassignificantly lower than patients who presented >6 hrs ofchest pain with 44.5% failure rate, p value 0.0002. Failure ofthrombolysis was higher in Diabetic patient (p value= 0.02)and hypertensive patient (p value= <0.0001). Risk factorslike diabetes, hypertension significantly affect the outcomeof thrombolysis. Mortality was seen in 10 patients, 80% hadfailed thrombolysis, p value< 0.001.Conclusion: Patients with No resolution of ST segment at 90min of thrombolysis had frequent adverse events and highermortality when compared to patients with partial and completeST segment resolution.
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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.
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Objective To observe the factors affecting inadequate ST-segment resolution in patients with acute ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention (PCI). Methods The patients with acute ST-segment elevation myocardial infarction undergoing emergency PCI were enrolled for study. According to the ratio of ST-segment resolution, 186 cases were divided into inadequate ST-segment resolution group (54 cases) and relatively adequate ST-segment resolution (132 cases). Clinical data of two groups were compared. The single factor and multiple Logistic regression analysis were performed to determine the factors influencing inadequate ST-segment resolution. Results Pre-infarction angina was protective factor of inadequate ST-segment resolution after emergency PCI (OR=0.361, 95%CI 0.131-0.994, P<0.05). Anterior myocardial infarction, attack-to-balloon time, Killip classification and white blood cell counts were risk factors of inadequate ST-segment resolution (OR=2.389, 95%CI 1.194-4.781;OR=1.655, 95% CI 1.082-2.532; OR=1.319, 95% CI 1.026-1.695; OR=1.184, 95% CI 1.004-1.396, P<0.05). Conclusions Patients with pre-infarction angina could reduce the risk of inadequate ST-segment resolution after PCI. Patients with anterior myocardial infarction,long attack-to-balloon time, Killip classification≥2 and high blood cell counts could increase the risk of inadequate ST-segment resolution, and earlier and more active clinical intervention should be taken.
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Objective To investigate the association of serum angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) with myocardial reperfusion in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). Methods A total of 103 consecutive STEMI patients who received primary PCI were enrolled in this study. The patients were divided into two groups according to ST-segment resolution (STR) at 2 h after PCI:STR ≥ 50%group (n=69) and STR0.05). In multivariable logistic regression analysis, Ang-2/Ang-1 before PCI was independently associated with STR < 50%;Other independent predictors were pain to balloon time, infarct related artery (LAD), and TIMI flow grade<Ⅲafter PCI. Conclusions Higher Ang-2/Ang-1 is an independent predictor of poor myocardial reperfusion in STEMI patients after PCI.
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Objective To analyze the ischemia degree of initial electrocardiogram in the patients of acute ST-segment elevation myocardial infarction (STEMI) and investigate its value in the predicting cardiogenic shock (CS) after percutaneous coronary intervention (PCI).Methods Three hundred and ninety patients with STEMI from the onset of symptoms to admission within 12 h were divided into two groups based on grade Ⅱ ischemia (group A,248 cases) or grade Ⅲ ischemia (group B,142 cases) in the initial electrocardiogram.Clinical data,TIMI risk score,ST-segment resolution (STR),CS and cardiovascular events (hospital mortality,ventricular arrhythmias,reinfarction) were recorded in all patients.Results The gender,time from onset to balloon opening,smoking,hypertension,type 2 diabetes,hyperlipidemia,stroke,postoperative TIMI flow 3 grade,coronary artery lesions and lesions in the left main stem between two groups was not statistically significant (P ＞0.05).In group B,the rate of ST segment resolution ＞ 50％ was significantly lower than that in group A [53.2％ (132/248) vs.29.6％ (42/142)] (P ＜ 0.01).The incidence of CS,in-hospital death,malignant ventricular arrhythmias in group B was higher than that in group A,and the difference was statistically significant (P ＜ 0.05).The age,left ventricular ejection fraction,TIMI risk score ＞ 3 points,Killip grade ＞ 1 grade,anterior myocardial infarction between two groups was statistically significant (P ＜ 0.05 or ＜ 0.01).The indicators that were statistically significant in the univariate analysis were included into Logistic regression model and analyzed,with CS-related factors as independent variables and CS as the dependent variable and found that age (P =0.008),Killip class ＞ 1 grade (P =0.049),ST segment resolution rate (P =0.008) and grade Ⅲ ischemia (P =0.001) as independent predictors of CS after PCI.Conclusions Grade Ⅲ ischemia is an independent predictor of CS after PCI in STEMI patients.And it has predictive value for hospital mortality and ventricular arrhythmias.
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Objective To survey ST-segment resolution in STEMI patients undergoing emergency percutaneous coronary intervention (PCI) and to find the specific clinical features of patients with inadequate ST-segment resolution.Methods A total of 198 patients were divided into two groups according to the ratio of ST-segment resolution:relatively adequate ST-segment resolution group (＞ 50％) and inadequate STsegment resolution group (＜ 50％).The clinical features,infarct-related artery and PCI-related evants were evaluated,and major adverse cardiovascular events (MACE including target vessel revascularization,recurrent myocardial infarction,or death) were recorded during hospitalization and follow-up period.Multivariate logistic analysis was used to identify relevant factors influencing ST-segment resolution of STEMI patients after treatment with PCI.The Statistical analyses of data were carried out using SPSS 10.0 software.Results (1) There were 156 patients with relativey adequate ST-segment resolution and 42 patients with inadequate ST-segment resolution.Of them,there were higher percentage of patients aged over 75years in the inadequate ST-segment resolution group than those in the relatively adequate ST-segment resolution group (9 cases,21.4％ vs.14 cases,9.0％ ; P ＜0.05).(2) In inadequate ST-segment resolution group,thetotal ischemic time was significant longer [(5.2 ±2.2) h vs.(3.0 ± 1.6) h,P ＜0.01].The infarctrelated artery (IRA) was more common at left anterior descending coronary artery (LAD) (27 cases,64.3％ vs.69 cases,44.2％; P ＜ 0.05) and there were fewer patients with TIM grade 3 of IRA in inadequate ST-segment resolution group after primary PCI than that in relative adequate ST-segment resolution group (32 cases,76.2％ vs.140 cases,89.7％ ; P ＜ 0.05).There was a lower rate of using GP Ⅱ b/Ⅲ a receptor antagonist and a higher rate of prescribing IABP in inadequate ST-segment resolution group.(3) There is a higher incidence of MACE during hospitalization and follow-up period in patients with inadequate ST-segment resolution.(4) Multivariate logistic analysis indicated that age over 75 years,LAD occlusion,the total ischemic time were related to ST-segment resolution.Conclusions The patients with age over 75 years,LAD occlusion,longer ischemia time,and unemployment GP Ⅱ b/Ⅲ a receptor antagonist before PCI were prone to get inadequate ST-segment resolution and poor prognosis.Age over 75 years,LAD occlusion,and longer ischemic time were independent risk factors of the inadequate ST-segment resolution in STEMI patients after emergency PCI.