Volume 24, Issue 105, September - October, 2020

The immediate outcome of thrombolytic therapy in ST-elevation myocardial infarction

Fadil Agla Bonyan¹, Laith G. Shareef^2♦, Assad Al-waily³

¹Emergency specialist, Member of Arabic Council of Emergency Medicine, Lecturer and trainer, Baghdad Teaching Hospital, Iraq; Email: Fadilagla66@gmail.com
²B.Sc. Pharmacy, Former Resident at Iraqi Board of Clinical Pharmacy, Medical City, Iraq, Email: laithalkunani@yahoo.com
³Board Family Medicine, Imam Ali General Hospital, Iraq; Email: asaad_a3w@yahoo.com

^♦Corresponding author
B.Sc. Pharmacy, Former Resident at Iraqi Board of Clinical Pharmacy, Medical City, Iraq, Email: laithalkunani@yahoo.com

ABSTRACT

Background: Plaque rupture and thrombus development play a major role in the genesis of acute coronary occlusion. The introduction of thrombolytic therapy was the main advance in the management of acute ST-elevation myocardial infarction (STEMI) since over 90 percent of such patients have complete occlusion of the culprit artery. Due in part to insufficient availability of primary PCI, fibrinolysis persists a vital therapeutic option. The earlier reperfusion occurs, the greater the benefit that can be achieved. The survival rate is elevated when thrombolytic drugs are prescribed within the first 4 hours after the onset of symptoms, especially, within the first seventy minutes. Objective: To evaluate the immediate effect of fibrinolytic therapy in patients admitted to the coronary care unit with acute myocardial infarction. Methods: A retrospective study was carried out at Baghdad Teaching Hospital/ cardiac care unit (CCU) during the period from June 2018 – January 2019. All patients with chest pain with confirmed ST-elevation MI were included (40) patients. The patients divided into two groups: Group no.1 patients receive thrombolytic therapy within a period less than three hours from onset of chest pain, Group no. 2 patients receive thrombolytic therapy within a period between three hours to twelve hours from onset of chest pain. Result: A total of 40 patients who were presented with STEMI were included in this study. The patients were 31(77.5%) males and 9 (22.5%) were females. The mean age was 61.27 ± 9.47. There was a statistically significant relationship between risk factors, diabetes mellitus (P=0.004), ischemic heart disease (P= 0.029), hypertension (P=0.003), gender (P=0.011), and alcohol (P=0.033) and the occurrence of Acute myocardial infarction (AMI) and the impact of time to thrombolytic medication on outcome in patients with acute myocardial infarction. Statistical significant between thrombolytic administration and the basal crackle as a complication (P= 0.011) as a result of delay the time to delivery of fibrinolytic therapy. Conclusion: The most important factor in determining outcomes in patients who present with a STEMI is the time taken from onset to reperfusion. The little risk for dying through acute hospitalization period was seen for those treated with tissue plasminogen activator within two hours of acute symptoms. Elderly, women, hypertensive, and diabetic patients had longer delays at all stages. Prior infarction was an added risk factor for treatment delay.

Keywords: Thrombolytic, Fibrinolytic, Myocardial Infarction

Medical Science, 2020, 24(105), 2979-2984

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