Early in-Hospital re-infarction after thrombolysis for acute myocardial infarction [AMI] in AFIC/NIHD Rawalpindi

ABSTRACT

This study was designed to determine the frequency and variables of in-hospital re-infarction after streptokinase in patients with first acute ST segment elevation myocardial infarction [AMI], hospitalized in CCU of AFIC/NIHD from Feb 2002 to July 2002. Of 200 consecutive patients of AMI who received streptokinase, 73% [n = 146] were males and 27% [n = 54] were females, mean age was 55.5 years [29-81]. Frequency of in-hospital re-infarction documented in this study was 6.5% [n = 13] a median time of 2.5 days [1-6] after thrombolysis. Patients with re-infarction had higher in-hospital mortality within ten days of hospitalization [30.77% versus 7.5% without re-infarction; P = .01]. Median time to death after re-infarction was 3 days [2 - 10] with 50% of deaths occurring within 48 hours of re-infarction. Rates are comparable with previously conducted large-scale studies [GUSTO I/III and TAMI study]. Advanced age, diabetes mellitus, hypertension, increasing killip class > at the time of admission, fluctuation in heart rate and hyperilipidaemias were the most important predictors /variables associated with higher in-hospital re-infarction and subsequent increased morbidity and mortality. Improved treatment, preventive strategies and early detection of re-infarction should be an important goal of AMI management. Repeat thrombolysis and early revascularization where possible in selected cases can decrease the cardiac mortality and morbidity