In hospital outcome of acute myocardial infarction in patients receiving Streptokinase

To study and compare the in-hospital mortality due to acute myocardial infarction in patients receiving thrombolytic [streptokinase] therapy versus those who were not thrombolysed. This descriptive observational study was conducted at the Coronary care Unit and Cardiology ward of Nishtar Hospital, Multan, from 10 of October 2002 till 30th of April 2003. Four hundred and thirty four patients of acute myocardial infarction who fulfilled WHO criteria of acute myocardial infarction were included in the study. Patients were divided into two groups: patients receiving streptokinase [SK] group and patients not receiving streptokinase [Non-SK] group. In-hospital mortality was our primary endpoint. Mechanical and electrical complications occurring in-hospital after acute myocardial infarction were secondary endpoints. Only 47% patients received streptokinase while 53% did not receive it because of delayed presentation or some other contraindication to streptokinase therapy. Mean age of the SK group was 51.58+11.02 years and Non-SK group was 55.78+10 years. In SK group 170[83.3%] patients were males and 34[16.7%] were females. Only 54[26.5%] diabetics and 150[73.5%] non-diabetics received streptokinase. Streptokinase recipients reached the hospital earlier; mean time of onset of symptoms till arrival at the hospital was 4 hours and 25 minutes while non recipients took a longer time in reaching to the hospital. There was no significant difference in the infarct territory between the two groups. The Non-SK group had higher Killip class as compared to SK group on presentation to the hospital. In-hospital mortality was 8.3% in SK group and 24.3% in Non-SK group [p<0.0001]; left ventricular failure occurred more frequently in Non-SK group and was the most common cause of death in both the groups [p<0.0001]. Only 4.3% patients in the SK group and 19.6% patients in the Non-SK group died in first 24 hours of hospital admission [p<0.0001]. Mechanical complications occurred more frequently in Non-SK group [p<0.008]. There was a statistically non significant difference [p<0.436] noted in comparison of electrical complications between the two groups. Streptokinase infusion given in the early hours of acute myocardial infarction leads to a significant reduction in in-hospital mortality and mechanical complications like left ventricular failure

Electrocardiographic patterns of Atrial Septal defects

This study was designed to evaluate the electrocardiographic features of Atrial Septal Defect to establish an association with crochetage pattern and incomplete RBBB. ASDs of Primum, Secundum and Sinus Venosus type were included in this study. From October 15, 2003 till January 15, 2004, a total of 104 consecutive patients of ASD were studied at Punjab Institute of Cardiology, Lahore. Patients were included in the study after confirmation of Atrial Septal Defect on transesophageal echocardiography. The mean age of the study population was 26.28 +/- 11.40 years. Among these 56[53.8%] patients were females and 48[46.2%] patients were males. The study population consisted of 94[90.4%] Secundum ASD patients followed by Sinus Venosus ASD 8[7.7%] patients and Primum ASD in only 2[l.9%] patients. Only 59[56.7%] patients had crochetage pattern in any of the leads while it was absent in 45[43.3%] patients p=0.470. Incomplete RBBB was present in 92[88.4%] patients. It was observed in 2[1.9%] patients in ASD Primum, 82[78.8%] patients in ASD Secundum and 8[7.7%] patients in ASD Sinus Venosus type. P=0.483. Although we did not observe a statistically significant association between crochetage pattern or incomplete RBBB and ASD but the presence of any of these two considerably increases the specificity of the ECG for the diagnosis of ASD

In hospital mortality of acute myocardial infarction in patients with and without renal dysfunction

To compare in-hospital mortality of acute myocardial Infarction in patients having normal renal functions with renal dysfunction patients. Emergency ward, Coronary care units and cardiology wards of the Punjab Institute of Cardiology Lahore. It was a comparative study. Sample size: 1000 consecutive patients presenting with acute myocardial infarction admitted to the Punjab Institute of cardiology Lahore were studied from 1st March 2004 to 15th August 2004. After fulfilling the inclusion criteria 1000 patients were studied. The mean age of the study population was 60.8+9.38 years. Total number of males in the study population was 642[64.2%] while female patients were 358[35.8%]. Patients with any degree of renal dysfunction, except those with end-stage renal disease were more likely to present with anterior MI than were patients without renal dysfunction. Patients with end-stage renal disease and more severe renal dysfunction were more likely to develop heart failure during hospitalization, to experience atrial fibrillation, and to have mechanical complications. Streptokinase therapy was used less frequently in patients with any degree of renal dysfunction than in patients without renal dysfunction, despite a similar incidence of MI. In-hospital mortality was 51[12%] in Group I patients, 46[16.6%] in Group II patients, 36[22%] in Group III patients, 35[27.7%] in Group IV patients and 5[35.7%] in Group V patients with a p value of <0.0001. Severe renal insufficiency had the maximum in-hospital mortality with OR of 5.4 and 95% confidence interval of 2.9-10.3 followed by end stage renal disease OR 5.1 [CI 2.2-12.1], moderate renal insufficiency OR 4.1 [CI 2.3-7.2] and mild renal insufficiency OR 1.9[CI 1.1-3.1] with a p value of <0.0001. Similarly congestive heart failure during hospital stay was observed in 20[4.7%] patients in Group I, 17[6.1%] patients in Group II, 15[9.4%] patients in Group III, 16[12.6%] patients in Group IV and 4[28.6%] patients in Group V. Similar trends were observed in mechanical complications and post myocardial arrhythmias in the study population, Patients with renal dysfunction who have acute MI are a high-risk population and suffer from increased mortality once they are admitted to the hospital. This is because of presence of more risk factors in this sub set of patients