Thrombolysis failure with Streptokinase in ST elevation myocardial infarction

• Hela ben turkia

  regional hospital of Ben Arous

  https://orcid.org/0000-0002-3364-3067 (unauthenticated)

• Syrine Keskes

  emergency departement of regional hospital of Ben Arous

• Ines Chermiti

  emergency departement of abderrahmen Mami hospital

• Raja Fadhel

  emergency departement of regional hospital of Ben Arous

• Amel Ben Garfa

  emergency departement of regional hospital of Ben Arous

• Amira Tagougui

  emergency departement of regional hospital of Ben Arous

• hanene ghazali

  emergency departement of regional hospital of Ben Arous

• Sami Souissi

  emergency departement of regional hospital of Ben Arous

In patients with acute ST elevation myocardial infarction (STEMI), coronary reperfusion with primary percutaneous coronary intervention (PCI) or fibrinolysis improve the prognosis. The main reason to prefer PCI, if it can be performed timely within 120 minutes, is his high incidence of reperfusion compared to thrombolysis. About 25-50% of patients treated with streptokinase fail to achieve successful reperfusion and these patients have poor prognosis.

The aim of this study was to determine independent factors related to thrombolysis failure with Streptokinase in STEMI patients using clinical and electrocardiogram criteria.

Methods:

A prospective observational study conducted over 9 years including patients treated with Streptokinase for STEMI. Thrombolysis failure was defined using electrocardiogram criteria. Multivariate analysis was used to identify factors related to thrombolysis failure.

Results:

From a total of 510 patients included, 198 (37%) failed fibrinolysis. The mean age of those patients was 60±11 years, 83% of the population were male. The average delay chest pain to first medical contact (FMC) was 224±170 minutes. Door to needle time was less than 30 minutes.

The failure was associated with four variables including Female gender (aOR: 2.05, 95% CI 1.27-3.30; P<0.001), the delay from chest pain to FMC >180 min (aOR:2.413, 95% CI 1.67-3.47; p<0.001), Extended anterior infarct (aOR: 2.01, 95% CI 1.05-3.84; p=0.033) and cardiogenic Shock (aOR: 7.12, 95%CI 1.66-30.48; p=0.008).

Conclusion:

Streptokinase had a failure rate of 37%. Female gender, a longer delay from pain to first medical contact, extended anterior infarction and cardiogenic shock were highly predictive of thrombolysis failure.

1. Syrine Keskes, emergency departement of regional hospital of Ben Arous

   emergency doctor and medical assistant 

2. Ines Chermiti, emergency departement of abderrahmen Mami hospital

   emergency doctor and professor 

3. Raja Fadhel, emergency departement of regional hospital of Ben Arous

   assisstant professor in emergency medecine

4. Amel Ben Garfa, emergency departement of regional hospital of Ben Arous

   general practitioner

5. Amira Tagougui, emergency departement of regional hospital of Ben Arous

   general practitioner

6. hanene ghazali, emergency departement of regional hospital of Ben Arous

   Professor in emergency medecine

7. Sami Souissi, emergency departement of regional hospital of Ben Arous

   MD, Professor Emergency Medicine

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