ABSTRACT
OBJECTIVE: To study clinical outcomes of recombinant tissue plasminogen activator (alteplase) as primary fibrinolytic drug in patients with acute STEMI in Buriram Hospital. MATERIAL AND METHOD: Data on demographics, medications, in-hospital outcomes, and angiography were collected from a prospective registry of STEMI patients admitted by STEMI fast track from January 1, 2011 to December 31, 2013. RESULTS: During the 3-year period, 97 consecutive patients with STEMI who received alteplase were enrolled. The mean age was 64.3 year and 75.3% were male. There were high prevalence of dyslipidemia and current smoking. Median time from symptom onset to hospital presentation was 170 minutes. Median door to needle time was 30 minutes. Thrombolytic therapy was started in 30 minutes in 55. 7% of cases. Overall bleeding was 19.6%. Intracranial hemorrhage was 1.0% of patients. ST-segment resolution was found in 79.4% of patients. In-hospital mortality was 11.3%. Angiographic data (n = 45) in patients with clinical reperfusion (n = 32), TIMI flow grade 2 and 3 combined was 90.6% and TIMI flow grade 3 was 56.3%. Revascularization was performed in 90.6%. CONCLUSION: Alteplase in acute STEMI provided good clinical reperfusion with minimal major bleeding complication. Most of patients with clinical reperfusion required additional percutaneous coronary intervention to fix residual stenosis of infarct related artery.
