Thrombolysis failure with streptokinase in acute myocardial infarct using ECG criteria - HUSM experience

Yeh, Lee Yeong (2006) Thrombolysis failure with streptokinase in acute myocardial infarct using ECG criteria - HUSM experience. Masters thesis, Universiti Sains Malaysia.

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Abstract

Streptokinase has high thrombolysis failure rate despite being cheap and widely used in acute myocardial infarction. Electrocardiogram criteria using more than 50% reduction in ST elevation in the worst infarct lead predicted TIMI Ill flow with good sensitivity and specificity. The primary objective of this study was to determine the failure rate of thrombolysis with streptokinase in acute myocardial infarction using electrocardiogram criteria in Hospital Universiti Sains Malaysia (HUSM). The secondary objective was to compare the association between independent variables, treatment and outcome parameters with failure of thrombolysis with streptokinase. A total of 192 subjects were recruited into this retrospective cohort observational study. 109 patients (56.8%) has failed thrombolysis with streptokinase. Seven variables were significantly associated with thrombolysis failure using streptokinase in a univariate analysis including anterior location of myocardial infarct (p<0.001 ), longer symptom-to-needle time (p=0.01 ), longer door-to-needle time (mean 114 ± 82.9 min, p=0.03), history of hypertension (p=0.04), higher heart rate (mean 79.3 ± 18.3 beats per min, p=0.01 ), higher systolic blood pressure (mean 136.7 + 28.9 mmHg, p=0.02) and higher diastolicblood pressure (mean 83.8 .± 20.9 mmHg, p=0.003). Five variables were associated with streptokinase failure as thrombolytic agent in multiple logistic regression analysis (backward stepwise method) including anterior location of myocardial infarct (p<0.001; OR 0.07, 95% Cl 0.03 - 0.16), longer door-to-needle time (p=0.02; OR 1.01, 95% Cl 1.00 - 1.02), diabetes mellitus (p=0.03; OR 3.13, 95% Cl 1.13 - 8.69), hypertension (p=0.08; OR 2.06, 95°/o Cl 0.92 - 4.60) and high total white cell count (p=0.03; OR 1.12, 950fc, Cl 1.01 - 1.24). Both recurrent acute coronary syndrome (p=0.02; crude OR 2.49, 95o/o Cl 1.16 - 5.32) and death after one year (p= 0.04; crude OR 7.61, 95°/o Cl 0.95 - 61.24) were associated with increase in the rate of thrombolysis failure with streptokinase in univariate analysis. In conclusion, the result of this study has shown that streptokinase has higher failure rate of thrombolysis in acute myocardial infarction using electrocardiogram criteria in HUSM. History of diabetes mellitus, history of hypertension, anterior location of myocardial infarction, longer door-to-needle time and high total white cell count were highly predictive of increase in the rate of thrombolysis failure using streptokinase. This group of patients may benefit from other early reperfusion strategy including tissue plasminogen activators (tPA), PCI or CABG.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Myocardial infarction
Subjects: R Medicine > RC Internal medicine > RC666-701 Diseases of the circulatory (Cardiovascular) system
Divisions: Kampus Kesihatan (Health Campus) > Pusat Pengajian Sains Perubatan (School of Medical Sciences) > Thesis
Depositing User: Mr Abdul Hadi Mohammad
Date Deposited: 29 Sep 2020 04:16
Last Modified: 29 Sep 2020 04:16
URI: http://eprints.usm.my/id/eprint/47413

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