Angiographic patency of streptokinase in STEMI patients: smokers vs. non-smokers

Authors

  • Iranna Hirapur Department of Cardiology, MRMC Kalaburagi, Karnataka, India
  • Srinivas Setty Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research Centre, Bangalore, Karnataka, India
  • Ravindran Rajendran Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research Centre, Bangalore, Karnataka, India
  • Manjunath Nanjappa Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research Centre, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20184875

Keywords:

Thrombolytic therapy, Smokers, STEMI, Streptokinase

Abstract

Background: Acute coronary syndrome is one of the leading causes of death. Smoking is known to be associated  with many influencing factors for accelerating Myocardial Infarction (MI). In a country like India, Streptokinase (SK) is used as a leading therapeutic option for the treatment of ST elevation myocardial Infarction (STEMI). SK combines with plasminogen; this SK-plasminogen complex is responsible for fibrinolysis. The aim of this study was to determine angiographic patency after SK infusion in STEMI patients and comparison between smokers and non-smokers.

Methods: In this observational, prospective and single-centre study conducted between September 2011 and April 2012, a total of 398 patients who were diagnosed with STEMI were included. Patients were divided in two groups i.e. smokers and non-smokers. The patients were treated with thrombolytic (streptokinase) therapy and evaluated for TIMI 3 flow by performing angiography within 72hours of thrombolysis with SK.

Results: Of total 398 patients, 348 (87.4%) were male. The ratio of non-smokers and smokers was 1:2. Smokers were younger than the non-smokers (48.8±10.2 vs. 54.57±9.51). Post thrombolytic therapy, patients were evaluated for TIMI flow grades. Total of 202 patients achieved TIMI 3 flow, of which 157 were smokers and 45 were non-smokers.

Conclusions: Smokers have relatively hypercoagulable state than non-smokers. Better outcome in smokers group may be because of younger age and lesser comorbidities. Smokers should be motivated and guided properly to quit smoking.

References

Mendis S, Thygesen K, Kuulasmaa K, Giampaoli S, Mähönen M, Ngu Blackett K, et al. World Health Organization definition of myocardial infarction: 2008-09 revision. Int J Epidemiol. 2010;40(1):139-46.

Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet. 2017;389(10065):197-210.

White HD, Van de Werf FJ. Thrombolysis for acute myocardial infarction. Circ. 1998;97(16):1632-46.

White H. Selecting a thrombolytic agent. Cardiol Clin. 1995;13(3):347-54.

Banerjee A, Chisti Y, Banerjee U. Streptokinase-a clinically useful thrombolytic agent. Biotechnol Adv. 2004;22(4):287-307.

Ali MR, Salim Hossain M, Islam MA, Saiful Islam Arman M, Sarwar Raju G, Dasgupta P, et al. Aspect of thrombolytic therapy: a review. Scientific World J. 2014;2014:8.

Grundy SM, Pasternak R, Greenland P, Smith S, Fuster V. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American heart association and the American college of cardiology. Circ. 1999;100(13):1481-92.

Jaatun HJ, Sutradhar SC, Dickstein K. Comparison of mortality rates after acute myocardial infarction in smokers versus non-smokers. Am J Cardiol. 2004;94(5):632-6.

Suriñach J, Alvarez L, Coll R, Carmona J, Sanclemente C, Aguilar E, et al. Differences in cardiovascular mortality in smokers, past-smokers and non-smokers: findings from the FRENA registry. Eur J Intern Med. 2009;20(5):522-6.

Gupta T, Kolte D, Khera S, Harikrishnan P, Mujib M, Aronow WS, et al. Smoker's paradox in patients with st‐segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. J Am Heart Assoc. 2016;5(4):e003370.

Chen KY, Rha SW, Li YJ, Jin Z, Minami Y, Park JY, et al. ‘Smoker's paradox’in young patients with acute myocardial infarction. Clin Exp Pharmacol Physiol. 2012;39(7):630-5.

Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR. ESC/ACCF/AHA/WHF expert consensus document. Circ. 2012;126(16):2020-35.

Nikus K, Birnbaum Y, Eskola M, Sclarovsky S, Zhong-qun Z, Pahlm O. Updated electrocardiographic classification of acute coronary syndromes. Curr Cardiol Review. 2014;10(3):229-36.

Trialists FT. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet. 1994;343(8893):311-22.

Investigators G. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med. 1993;329(10):673-82.

Gerber Y, Rosen LJ, Goldbourt U, Benyamini Y, Drory Y, Infarction ISGoFAM. Smoking status and long-term survival after first acute myocardial infarction: A population-based cohort study. J Am Coll Cardiol. 2009;54(25):2382-7.

Rakowski T, Siudak Z, Dziewierz A, Dubiel JS, Dudek D. Impact of smoking status on outcome in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. J Throm Thrombolysis. 2012;34(3):397-403.

Robertson JO, Ebrahimi R, Lansky AJ, Mehran R, Stone GW, Lincoff AM. Impact of cigarette smoking on extent of coronary artery disease and prognosis of patients with non–ST-segment elevation acute coronary syndromes: an analysis from the ACUITY trial (Acute Catheterization and Urgent Intervention Triage Strategy). JACC Cardiovasc Inter. 2014;7(4):372-9.

Juliard J-M, Golmard JL, Himbert D, Feldman LJ, Delorme L, Ducrocq G, et al. Comparison of hospital mortality during ST-segment elevation myocardial infarction in the era of reperfusion therapy in women versus men and in older versus younger patients. Am J Cardiol. 2013;111(12):1708-13.

Arbel Y, Matetzky S, Gavrielov-Yusim N, Shlezinger M, Keren G, Roth A, et al. Temporal trends in all-cause mortality of smokers versus non-smokers hospitalized with ST-segment elevation myocardial infarction. Int J Cardiol. 2014;176(1):171-6.

Arbel Y, FitzGerald G, Yan AT, Tan MK, Fox KA, Gore JM, et al. Temporal trends in all-cause mortality according to smoking status: Insights from the Global Registry of Acute Coronary Events. Int J Cardiol. 2016;218:291-7.

Aune E, Røislien J, Mathisen M, Thelle DS, Otterstad JE. The" smoker's paradox" in patients with acute coronary syndrome: a systematic review. BMC Med. 2011;9(1):97.

Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290(1):86-97.

Volpp KG, Troxel AB, Pauly MV, Glick HA, Puig A, Asch DA, et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med. 2009;360(7):699-709.

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Published

2018-11-26

How to Cite

Hirapur, I., Setty, S., Rajendran, R., & Nanjappa, M. (2018). Angiographic patency of streptokinase in STEMI patients: smokers vs. non-smokers. International Journal of Research in Medical Sciences, 6(12), 3813–3818. https://doi.org/10.18203/2320-6012.ijrms20184875

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Original Research Articles