MVP Journal of Medical Sciences

Open Access Open Access  Restricted Access Subscription Access

Comparative Outcome Study between Resolved and Unresolved St Segment in St Segment Elevation Acutemyocardial Infarction (STEMI) after Thrombolytic Therapy


Affiliations
1 Former PG Resident, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422203, Maharashtra, India ., India
2 Professor, Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, India ., India
3 Professor, Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, India ., India
 

Background: To study the comparative outcome between resolved an unresolved ST segment in ST Segment Elevation Acute Myocardial Infarction (STEMI), after thrombolytic therapy. Method: A study was carried out on patients admitted with 1st episode of ST elevated myocardial infarction in MICU of a tertiary health care center of a teaching hospital. On admission detailed history was taken and a complete clinical examination was done. Thrombolysis was done using streptokinase, 2D ECHOs were performed before and after thrombolytic therapy. Result: Most of the study population in both the group (Unresolved STEMI and Successful thrombolysis), belonged to the age group of 41 to 50 years. Co-morbidities like hypertension were present in 83% of Unresolved STEMI and 53% of Resolved STEMI. Comorbidities like diabetes were present in 66.7% of Unresolved STEMI and 52.6% of Resolved STEMI. RWMA on 2D-Echo before thrombolysis was present in 58.3% of Unresolved STEMI and 47.4% of Resolved STEMI. RWMA on 2D-Echo after thrombolysis was present in 66.7% of Unresolved STEMI and 18.5% of Resolved STEMI. Conclusion: Symptom to needle time is an important predictor of whether thrombolysis will be successful or not in acute myocardial infarction patients. Hence it is important to educate the public about prompt recognition of symptoms and seeking medical help urgently. As the rate of unsuccessful thrombolysis is higher in patients with old age, diabetes, hypertension and dyslipidemia, such patients should be monitored and treated aggressively.

Keywords

Diabetes, Hypertension, RWMA - Regional Wall Motion Abnormalities, STEMI - ST Segment Elevation Myocardial Infarction, Thrombolysis
Font Size

User
Notifications

  • World Health Organization. World Health Organization; Geneva: 2005. Preventing Chronic Diseases: A Vital Investment.

  • Prevalence of Coronary Heart Disease - United States. 2006-2010. Morb Mortal Wkly Rep (MMWR). 2011; 60(40): 1377–81.

  • Mohan V, Deepa R, Rani SS. Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India. J Am Coll Cardiol. 2001; 38: 682–7. https:// doi.org/10.1016/S0735-1097(01)01415-2

  • Gupta R, Gupta VP, Sarna M. Prevalence of Coronary Heart Disease and risk factors in an urban Indian population: Jaipur Heart Watch-2. Indian Heart J. 2002; 54: 59–66.

  • Kamili MA, Dar IH, Ali G. Prevalence of Coronary Heart Disease in Kashmiris. Indian Heart J. 2007; 61: 44–9.

  • Gupta AK, Bharadwaj A, Ashotra S. Feasibility and training of multipurpose workers in detection, prevention and control of coronary artery disease in apple-belt of Shimla hills.South Asian J Prev Cardiol. 2002; 6: 17–22.

  • Kumar R, Singh MC, Ahlawat SK. Urbanization and coronary heart disease: A study of urban-rural differences in Northern India. Indian Heart J. 2006; 58: 126–30.

  • Ezzati M, Lopez AD, Rodgers A. World Health Organisation; Geneva: 2004. Comparative Quantification of Health Risks. Global and Regional Burden of Disease Attributable to Major Risk Factors.

  • Elliot MA, Loscalzo J. ST segment elevation myocardial infarction in Longo, Fauci, Kasper, Hauser, Jameson, Loscalzo. Harrison’s principles of Internal Medicine.18h ed. New York: McGraw Hill; 2012: 2021–35.

  • Elliot MA, Eugene Braunwald: STElevation MI in Libby P, Bonow RO, Zipes DP, Mann DL. BRAUNWALD’S Heart Disease. 8th ed. Philadelphia: Elsevier; 2008: 1207–300.

  • Elliot MA, Eugene Braunwald: STElevation MI in Libby P, Bonow RO, Zipes DP, Mann DL. BRAUNWALD’S Heart Disease. 8th ed. Philadelphia: Elsevier; 2008: 1207-1300.

  • Alexander AW, Prall CM, Ryan TJ, Robert R: ST elevation myocardial infarction in Valentine F, Alexander RW, Robert A, Robert R, Spencer B , Ira S, et al. Hurst’s The Heart. 11th ed. New York: McGraw Hill; 2004: 1277–351.

  • Alexander AW, Prall CM, Ryan TJ, Robert R: ST elevation myocardial infarction in Valentine F, Alexander RW, Robert A, Robert R, Spencer B , Ira S, et al. Hurst’s The Heart. 11th ed. New York: McGraw Hill; 2004: 1277–351.

  • Bajzer CT. Acute myocardial infarction. Medicine Index. Cleveland Clinic Foundation 2002: 222–6.

  • Suri A, Tincey S, Ahsan S, Meier P. Thrombolysis in myocardial infarction. Lakshmanadoss U (editor), Novel Strategies in Ischemic Heart Disease, 1st edition, 2012. ISBN: 978953-51-0184-0. In Tech. 2014. Available at: http:// www.intechopen.com/books/novel-strategies-in-ischemicheartdisease/thrombolysis-in-myocardialinfarction

  • Schroder R. Prognostic impact of early ST segment resolution in acute ST elevation myocardial infarction. Circulation. 2004; 110: 506–10. PMid: 15557381. https:// doi.org/10.1161/01.CIR.0000147778.05979.E6

  • van’t Hof AW, Liem A, de Boer MJ, Zijlstra F. Clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute myocardial infarction. Zwolle Myocardial Infarction Study Group. Lancet. 1997; 350: 615–29. https:// doi.org/10.1016/S0140-6736(96)07120-6

  • de Belder MA. Acute myocardial infarction: Failed thrombolysis. Heart. 2001; 85: 104 –12. Bajzer CT. Acute myocardial infarction. Medicine Index. Cleveland Clinic Foundation 2002: 222-26. 2. PMid: 11119477 PMCid: PMC1729601. https://doi.org/10.1136/heart.85.1.104

  • Chyun DA, Young LH, Diabetes Mellitus and Cardio Vascular Disease, Nurs Clin N Am. 2006; 41: 681–95. PMid: 17059982. https://doi.org/10.1016/j.cnur.2006.07.007

  • Ismail J, Jafar TH, Jafary FH, White F, Faruqui AM, et al. Risk factors for non-fatal myocardial infarction in young South Asian adults. Heart. 2004; 90: 259–63. PMid: 14966040 PMCid: PMC1768096. https://doi.org/10.1136/ hrt.2003.013631

  • Enas EA, Metha J. Malignant coronary artery disease in young Asian Indians: Thoughts on pathogenesis, prevention and therapy. Coronary Artery Disease in Asian Indians CADI Study. Clin Cardio. 1995; l3: 131–5. PMid: 7743682. https://doi.org/10.1002/clc.4960180305

  • Huma S, Tariq R, Amin F, Mahmood KT. Modifiable and Non-modifiable predisposing risk factors of myocardial infarction - A review. J Pharm Sci and Res. 2012; 4(1): 1649–53.

  • Fresco C, Avanzini F, Bosi S. Prognostic value of a history of hypertension in 11,483 patients with acute MI treated with thrombolysis. GISSI-2 Investigators. Gruppo Italiano per lo Studio della, Sopravvivenanell’Infarto Miocardico.J Hypertens.1996; 14: 743–50. PMid: 8793697. https://doi.

  • org/10.1097/00004872-199606000-00010

  • Lee YY, Tee MH, Zurkurnai Y. Thrombolytic failure with streptokinase in acute myocardial infarction using electrocardiogram criteria. Singapore Med J. 2008; 49: 304–10.

  • GISSI-2: In hospital mortality and clinical course of 20891 patients with suspected Acute MI randomized between alteplase and streptokinase with or without heparin. Lancet.1990; 336: 71–5. https://doi.

  • org/10.1016/0140-6736(90)91590-7

  • Angeja BG, Lemos J, Murphy SA, Antman EM, Cannon CP, Braunwald E. Impact of diabetes mellitus on epicardial and microvascular flow after fibrinolytic therapy. Am Heart J. 2002; 144: 649–56. PMid: 12360161. https:// doi.org/10.1016/S0002-8703(02)00136-9 https://doi. org/10.1067/mhj.2002.124869

  • Chowdhury MAR, Hossain AKMM, Dey SR. A comparative study on the effect of streptokinase between diabetic and non-diabetic myocardial infarction patients. Bangladesh J Pharmacol. 2008; 3: 1–7. https://doi.org/10.3329/bjp. v3i1.822

  • Kharash LM, Gol’dkhammer EI, Abinader EG. The clinical aspects of thrombolytic therapy with streptokinase in myocardial infarct. Ter Arkh.1996; 68(12): 53–7.

  • Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute MI: A quantitative review of 23 randomized trials. Lancet. 2003; 361: 13–20 https://doi.org/10.1016/S0140-6736(03)12113-7

  • GISSI- 2: In hospital mortality and clinical course of 20891 patients with suspected Acute MI randomized between alteplase and streptokinase with or without heparin. Lancet.1990; 336: 71–5. https://doi. org/10.1016/0140-6736(90)91590-7

  • Shah A, Galen SW, Christopher BG, Christopher MO, Cynthia LG, Kathleen MT, et al. Prognostic implications of TIMI flow grade in infarct related artery compared with 12 lead ST segment resolution analysis. J Am Coll Cardio. 2000; 35: 666–72. https://doi.org/10.1016/S0735-

  • (99)00601-4

  • Gabriel IB, Arie R, Hanoch H, Hilton IM, Schemuel R, Yedahel HZ, et al. Rapid resolution of ST elevation and prediction of clinical outcome in patients undergoing thrombolysis with alteplase. Heart. 1990; 64: 241–7. PMid: 2121199 PMCid: PMC1024413. https://doi.org/10.1136/hrt.64.4.241 .


Abstract Views: 132

PDF Views: 75




  • Comparative Outcome Study between Resolved and Unresolved St Segment in St Segment Elevation Acutemyocardial Infarction (STEMI) after Thrombolytic Therapy

Abstract Views: 132  |  PDF Views: 75

Authors

Satish Kamthe
Former PG Resident, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422203, Maharashtra, India ., India
Deodatta Chafekar
Professor, Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, India ., India
Neelima Chafekar
Professor, Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, India ., India

Abstract


Background: To study the comparative outcome between resolved an unresolved ST segment in ST Segment Elevation Acute Myocardial Infarction (STEMI), after thrombolytic therapy. Method: A study was carried out on patients admitted with 1st episode of ST elevated myocardial infarction in MICU of a tertiary health care center of a teaching hospital. On admission detailed history was taken and a complete clinical examination was done. Thrombolysis was done using streptokinase, 2D ECHOs were performed before and after thrombolytic therapy. Result: Most of the study population in both the group (Unresolved STEMI and Successful thrombolysis), belonged to the age group of 41 to 50 years. Co-morbidities like hypertension were present in 83% of Unresolved STEMI and 53% of Resolved STEMI. Comorbidities like diabetes were present in 66.7% of Unresolved STEMI and 52.6% of Resolved STEMI. RWMA on 2D-Echo before thrombolysis was present in 58.3% of Unresolved STEMI and 47.4% of Resolved STEMI. RWMA on 2D-Echo after thrombolysis was present in 66.7% of Unresolved STEMI and 18.5% of Resolved STEMI. Conclusion: Symptom to needle time is an important predictor of whether thrombolysis will be successful or not in acute myocardial infarction patients. Hence it is important to educate the public about prompt recognition of symptoms and seeking medical help urgently. As the rate of unsuccessful thrombolysis is higher in patients with old age, diabetes, hypertension and dyslipidemia, such patients should be monitored and treated aggressively.

Keywords


Diabetes, Hypertension, RWMA - Regional Wall Motion Abnormalities, STEMI - ST Segment Elevation Myocardial Infarction, Thrombolysis

References





DOI: https://doi.org/10.18311/mvpjms%2F2022%2Fv9i1%2F294