Effectiveness of thrombolytic therapy in patients with acute myocardial infarction within 12 hours of symptoms
Keywords:Diabetes mellitus, ST-elevation myocardial infarction, ST-segment resolution, Thrombolytic therapy
Background: Atherosclerotic coronary artery disease particularly myocardial infarction is the leading cause of morbidity and mortality all over the world and its incidence is also on the rise in Pakistan. This study was done to assess the effectiveness of thrombolytic therapy in patients with acute myocardial infarction and comparison between diabetics and non- diabetics.
Methods: This cross sectional study was conducted at Department of Cardiology, Bahawal Victoria Hospital, Bahawalpur from January to June 2019. Total 380 patients of aged 30-70 years either male or female with diagnosis of acute ST-elevation myocardial infarction presenting within 12 hours of the onset of chest pain were selected. Patients were given thrombolytic therapy with Streptokinase 1.5 MIU over 1 hour and post therapy, efficacy was assessed.
Results: Mean age of the patients was 51.37±10.08 years. Mean duration of diabetes mellitus was 5.99±3.47 years. Duration of chest pain ranged from 1 hour to 12 hours with mean duration of 4.66±2.98 hours. Out of 380 patients of MI, treatment was found effective in 202 (53.2%) patients. Female gender, type of MI, and duration of chest pain were significantly associated with reduced efficacy (p value < 0.05). Presence of hypertension, smoking, dyslipidemia or family history of MI did not alter the efficacy significantly (p>0.05) while patients having diabetes had significantly reduced efficacy (p value < 0.001).Conclusions: There is reduced effectiveness of thrombolytic therapy in diabetic patients with ST elevation myocardial infarction.
Jafar TH, Qadri Z, Chaturvedi N. Coronary artery disease epidemic in Pakistan: more electrocardiographic evidence of ischaemia in women than in men. Heart. 2008 Apr 1;94(4):408-13.
Gill BA, Ramzan M, Ahmed N, Abbas T, Qureshi BA, Saleemi MS, et al. Efficacy of Streptokinase in diabetic and non-diabetic patients presenting with acute ST elevation myocardial infarction. Pak Heart J. 2014;47(02):96-9.
Shah I, Hafizullah M, Shah ST, Gul AM, Iqbal A. Comparison of the efficacy & safety of thrombolytic therapy for ST elevation myocardial infarction in patients with and without diabetes mellitus. Pak Heart J. 2012;45(01):33-8.
Masoomi M, Samadi S, Sheikhvatan M. Thrombolytic effect of streptokinase infusion assessed by ST-segment resolution between diabetic and non-diabetic myocardial infarction patients. Cardiol J. 2012;19(2):168-73.
Khan MA, Khawaja MN, Hakeem F. Predicting clinical outcome in diabetics vs. non diabetics with acute myocardial infarction after thrombolysis, using ECG as a tool. J Pak Med Assoc. 2011;61(10):1032-7.
Uddin MF, Hoque AKF. Impact of diabetes mellitus on the effect of streptokinase in acute myocardial infarction patients. Med Today. 2012;24(01):16-9.
Gaziano TA, Prabhakaran D, Gaziano JM. Global burden of cardiovascular disease disease. In: Mann DL, Zipes DP, Libby P, Bonow RO. Braunwald’s heart disease. Philadelphia: Elsevier; 2015;1-20.
Sulehria SB, Nabeel M, Awan AK et al Failure of Streptokinase Therapy in Diabetic and Non-Diabetic Patients Presenting with ST Elevation Myocardial Infarction Pak J Med Health Sci. 2014;8(3):750.
Shah I, Hafizullah M, Shah ST, Gul AM, Iqbal A. Comparison of the efficacy and safety of thrombolytic therapy for ST-elevation myocardial infarction in patients with and without diabetes mellitus. Pak Heart J. 2012;45(1):33-8.
Kocayigit I, Yaylaci S, Osken A, Aydın E, Salih S, Yusuf C, et al. Comparison of effects of thrombolytic therapy and primary percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction on in-hospital, six-month, and one-year mortality. Arch Med Sci Atheroscler Dis. 2019;4:e82‐8.
Bawaskar HS, Bawaskar PH, Bawaskar PH. Preintensive care: Thrombolytic (streptokinase or tenecteplase) in ST elevated acute myocardial infarction at peripheral hospital. J Family Med Prim Care. 2019;8(1):62‐71.
Gupta A, Joshi P, Mohan V, Reddy KS, Yusuf S. Epidemiological and causation of coronary heart disease and stroke in India. Heart J. 2008;94(1):16-26.
Gupta R, Gupta VP, Ahluwalia NS. Educational status, coronary heart disease, and coronary risk factor prevalence in a rural population of India. BMJ. 1994 Nov 19;309(6965):1332-6.