EFFICACY OF THROMBOLYTIC THERAPY IN THE TREATMENT OF ACUTE MYOCARDIAL INFARCTION (AMI)

Ermir Mile, Idriz Balla

Abstract

Acute Myocardial Infarction (AMI) is the immediate cessation of the blood supply to the heart muscle and occurs due to lack of oxygen and is one of the most frequent medical emergencies. ST-Elevation Acute Myocardial Infarction (STEMI)is one of the major cardiological emergencies which is associated with complications of heart failure, arrhythmia, and high mortality. The main treatment is coronary artery recanalization of the involved artery in the shortest time possible. Percutaneous transluminal coronary angioplasty has shown the best results of AMI treatment. Reperfusion of the ischemic myocardium can be achieved by pharmacologic methods (thrombolysis) and PCI (Percutaneous Coronary-arteries Intervention). Purpose of the study: The study is of cohort-prospective type. It is a study for the coronary-angiography evaluation of the current treatment of STEMI at the University Hospital Center in Tirana in patients undergoing thrombolysis with streptokinase or reteplase (choice is based on the specific case), and the effect of predisposing factors upon the mortality of STEMI. Materials and methods: this study included all patients admitted to the department of cardiologic resuscitation, from 01 Feb 2013, until 05 Jul 2013 (56 patients, of whom 26 were females and 30 were males, with an identical average age of 56.0 ±10.0 years old) diagnosed with STEMI in whom thrombolysis with reteplase or streptokinase has been performed according to previously tested protocols, respecting the absolute contraindications for the application of reperfusion procedure. Thrombolysis was performed in patients who presented within 6 hours since the onset of pain. Follow-up includes days of hospitalization (cardiology resuscitation + cardiology clinic I or II). Results: Data analysis showed Thrombolysis in Myocardial Infarction (TIMI) 3 in 82% of the total cases; The group of patients treated with streptokinase showed TIMI 3 of 70% and the group of patients treated with reteplase showed TIMI 3 of 91%. The total mortality rate was 6.9% (3 patients) and these were part of the group treated with reteplase. Predisposing factors for high mortality in patients undergoing thrombolysis such as age, sex, diabetes mellitus (DM) type II (prevalence of DM type II was 33.9% of all patients, of whom 41% of the patients treated with RP and 22% of patients treated with ST, p=0.0001) and TIMI had a statistical significantly higher risk factors in the group treated with reteplase. Conclusion: Thrombolysis of STEMI patients presents an effective recanalizing alternative when the patient presents within the first few hours since the onset of pain onset, a conclusion achieved by TIMI-based coronary angiography assessment. Mortality in thrombolysis is related to factors such as: age, gender, high blood pressure (BP), DM, and other comorbid factors.

Pages: 80 - 86