Efficacy and safety concerns with thrombolysis in acute myocardial infarction in Insein General Hospital (ESCORT-IGH).

ABSTRACT

Background - Although patients with ST elevation myocardial infarction should be ideally treated with primary coronary intervention (PCI), due to limited availability of PCI capable hospitals, thrombolysis remains the mainstay treatment in Myanmar. It is imperative that evidence is necessary to prove the efficacy and safety of thrombolysis in district hospital setting in Myanmar. Methods - Patients with acute myocardial infarction were studied during a period of 21 months in the medical ward of Insein General Hospital (IGH), a (300 bedded) hospital which has no facilities for PCI. Streptokinase was used for thrombolysis. Study was set up to achieve “call to needle time of 25 minutes”. Primary endpoint was ST resolution at 90 minutes post-thrombolysis and secondary endpoint was 7 days survival post-thrombolysis. Adverse reactions including haemorrhage were recorded. Results - One hundred and eighteen patients (78%) out of one hundred and fifty one study cases were eligible for thrombolysis. Among the thrombolysis patients, male to female ratio was 1.63 and mean age was 60 years (22 - 86 yr). Median time of thrombolysis since onset of pain was 4.7 hours. Primary end point of ST resolution at 90 min was achieved in 58% (69/118) in thrombolysis group and 0% (0/33) in non-thrombolysis group. Secondary end point of 7 day survival was achieved in 89% (105/118) in thrombolysis group and 6% (2/33) in non-thrombolysis group. Thrombolysis favours ST resolution (p < 0.0001) and 7 day survival (p < 0.0001) better than non-thrombolysis. Statistically non-significant minor bleeding (gum bleeding and epistaxis) was observed in 3% (4/118) (p = 0.52) in the treatment group but there was no fatal bleeding and anaphylaxis. Conclusion - Thrombolysis using streptokinase is safe and highly effective in acute ST-elevation myocardial infarction in district hospital setting.