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