ST elevated myocardial infarction: clinical manifestation and outcomes of thrombolysis in a tertiary care hospital

Authors

  • Ravishankar M. S. Department of General Medicine, BGS Global Institute of Medical Sciences, Bangalore, Karnataka, India
  • Harish Kumar S. Department of General Medicine, SDUMC, Kolar, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20183137

Keywords:

Acute myocardial infarction, Coronary artery disease, Ischemic heart disease, ST elevation myocardial infarction, Streptokinase

Abstract

Background: Acute myocardial infarction has reached enormous proportion in the developing countries and it is speculated that atherosclerotic heart disease will replace infectious disease as the leading cause of death in India. It has been shown that the thrombolytic therapy is underutilized. So, the study was taken to study the clinical manifestations and outcome of thrombolytic therapy in STEMI.

Methods: The study was conducted for a period of 18 months in a tertiary care centre during which 100 cases of STEMI admitted to ICCU were included in the study, after fulfilling the inclusion criteria for thrombolysis, data related to clinical profile and outcome of thrombolysis was collected. SPSS 16 was used to analyse the data. Descriptive statistics like proportions mean and SD were computed.

Results: Incidence of STEMI was high among subjects in the age group 51-60 years. Males were more affected (72%). Smoking, hypertension, hyperlipidemia and diabetes mellitus were the most common risk factors. Chest pain (92%) was the most common symptom. Majority (56%) were admitted within 6 hours of onset of symptoms. Anterior wall infarction was most common type of myocardial infarction. Majority (82%) were admitted in either Killips I/II class. Left Ventricular failure and Arrhythmias were most common complication. 64% patients had objective evidence in a form of ECG with ST-T resolution (>50%) between 1-6 hours, 18% between 6-24 hours and 18% patients had no significant resolution even after 24 hours. Echocardiography showed good left ventricle function (LVEF >45%) in 70% and 30% of the patients showed reduced ejection fraction (LVEF<45%). Mortality was seen in 8% of cases.

Conclusions: Smoking, hyperlipidemia, diabetes mellitus and hypertension were most important risk factors for MI in the study. Coronary pain relief was most frequent and early marker of reperfusion. The ST segment elevation resolution has been widely accepted as most reliable objective criteria of coronary reperfusion. Hence ST segment resolution is regarded as a marker of salvaged myocardium by post-thrombolytic reperfusion. Early reperfusion of the ischaemic myocardial tissue with thrombolytic therapy decreases the morbidity and mortality.

References

Guha S, Sethi R, Ray S, Bahl VK, Shanmugasundaram S, Kerkar P, et al. Cardiological society of India: Position statement for the management of ST elevation myocardial infarction in India. Indian Heart J. 2017 Apr 1;69:S63-97.

Antman EM, Braunwald E. ST segment elevation mycocardial infarction. In:

Zipes, Libby, Bonow, Braunwald eds. Braunwalds Heart disease a text

book of cardiovascular medicine. 7th ed. Philadelphia: Elsevier Saunders;

:1141-1142.

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. Fibrinolytic Therapy Trialists’(FTT) Collaborative Group. Lancet. 1994;343(8893):311-22.

Ghaffar A, Reddy KS, Singhi M. Burden of non-communicable diseases in South Asia. BMJ. 2004; 328:807-10.

Gupta R. Burden of coronary heart disease in India. Indian Heart J. 2005;57:632-8.

Streptokinase in acute myocardial infarction: a multicentric study in an Indian setting. Streptokinase Multicentric Trial Group. Indian Heart J. 1993 May-Jun;45(3):189-94.

The GUSTO Angiographic Investigators The effects of tissue plasminogen activator, streptokinase, or both on coronary artery patency, ventricular function, and survival after acute myocardial infarction. N Engl J Med. 1993;329:1615-22.

Braunwald and Antman. Harrison's Principles of Internal Medicine. 19th edition. New York: McGraw Hill Education; 2015;2(239):1543-1544.

Kumar R, Singh MC, Singh MC, Ahlawat SK, Thakur JS, Srivastava A, et al. Urbanization and coronary heart disease: a study of urban-rural differences in northern India. Indian Heart J. 2006 Mar-Apr;58(2):126-30.

Misiriya KJ, Sudhayakumar N, Khadar SA, George R, Jayaprakasht VL, Pappachan JM. The clinical spectrum of acute coronary syndromes: experience from a major centre in Kerala. J Assoc Physicians India. 2009 May;57:377-83.

Hanania G, Cambou JP, Guéret P, Vaur L, Blanchard D, Lablanche JM, et al. The USIC 2000 investigators: management and in-hospital outcome of patients with acute myocardial infarction admitted to intensive care units at the turn of the century: results from the French nationwide USIC 2000 registry. Heart. 2004;90:1404-10.

Gupta MC, Mehta L, Gupta SP. Clinical profile of acute myocardial infarction with special reference to risk factors-a five-year study. JAPI. 1989;37(1):55.

Dwivedi S, Anupam P, Chaturvedi A. Cardiovascular risk factors in young coronary heart disease patients around East Delhi. South Asian J Prevent Cardiol. 1997;1:21-6.

Parameshwara V. Ischemic heart disease an overview. JAPI. 1988;36(8):485.

Khan S, Abrar A, Abid AR, Jan T, Khan H. In-hospital outcome of patients having acute myocardial infarction with and without streptokinase. Gomal J Med Sci. 2009 Dec 31;7(2).

Schroder R. Prognostic impact of early ST-segment resolution in acute ST elevation myocardial infarction. Circulation. 2004;110:506-10.

de Lemos JA, Braunwald E. ST segment resolution as a tool for assessing the efficacy of reperfusion therapy. J Am Coll Cardiol. 2001 Nov 1;38(5):1283-94.

Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KA, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart J. 2003 Jan 1;24(1):28-66.

Jajoo U, Taksande B, Yelwatkar S, Kumar R. Resolution of coronary pain and settlement of elevated ST Segment after streptokinase thrombolysis in STEMI as a marker of prognosis. MGIMS. 2009;1601.

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Published

2018-07-23

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Original Research Articles