Details
Category: Volume 08 Issue 02 February 2020
Hits: 998

Title: Incidence of Cardiogenic Shock in Acute Stemi Patients Thrombolysed with Streptokinse

Authors: Dr Uddhav Khaire, Dr Rahul Rathod, Dr Shweta Shinde

 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.51

Abstract

Introduction: Thrombolysis therapy in randomized controlled trials has shown to improve the natural history of acute myocardial infarction with approximate 30% reduction in mortality. Non-invasive detection of reperfusion is an useful guide for future management. Resolution of ST segment elevation following thrombolytic therapy has been shown to be a simple and useful predictor of left ventricular function and clinical outcome. Reduction in ST segment elevation, relief from chest pain, early peaking of serum concentration of creatine kinase and reperfusion arrhythmias are some of the non-invasive markers of reperfusion.1

Farrer M et al. suggested that previous studies have shown an association between each resolution of ST elevation after thrombolysis and improved coronary patency and clinical outcome.2 Thrombolytic therapy for acute myocardial infarction reduces case fatality and improves clinical outcomes.5,6

Material and Methods: We conducted cross sectional observational study in 200 patients of acute ST segment elevation myocardial infarction. Outcome of early (within 6 hours) and late (after 6 hours) thrombolysis in patients of STEMI studied and compared.

Results: About the complication after receiving thrombolytic therapy 37 % were in cardiogenic shock, 27.5 % land up in CCF, 15% showed arrhythmias. most of cases 85 (42.5 %)ST segment resolution > 50% were seen where there is initiation of therapy before 6 hours, whereas only 41 (20.5%) of cases shows improve ST segment > 50% after 6 hours of initiation of therapy.

Conclusion: Complication like cardiogenic shock were significantly less in patients thrombolysed within 6 hours of onset of chest pain compared to those who thrombolysed after 6 hours.

References

  1. Schroder K. Extent of ST segment deviation in single ECG lead 90 minutes after thrombolysis as a predictor of medium term mortality in acute MI. Lancet 2001; 358:14:79-86.
  2. Farrer M. Change in ST segment elevation 60 min after thrombolytic initiation predicts clinical outcome accurately as later electrocardiographic Heart 1997;78:461-71.
  3. Anthon K. Prognostic clinical significance of ST segment potential determined by body surface mapping in patients with acute myocardial infarction. Circulation 1987;76(2):287.
  4. Resolution of ST-Segment Elevation in Acute Myocardial Infarction- Early Prognostic Significance after Thrombolytic Therapy Results from the COBALT Trial  Joerg Carlsson 1, Uwe Kamp 2, Dirk H~irtel 2, Johannes Brockmeier 2, Rainer Meierhenrich 3, Sinisa Miketic 2, Sabine Walter 2, Frans van de Werf 4, Ulrich Tebbe 2
  5. Gruppo Italiano per lo Studio della Streptochinasinell’ Infarto Miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986;i:397–402
  6. 2 ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988;ii:349–60
  7. Santoro GM, Valenti R, Buonamici P, et al. Relation between STsegment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with direct angioplasty. Am J Cardiol1998;82:932–7
  8. Schroder R, Dissmann R, Bruggemann T, et al. Extent of early ST segment elevation resolution: a simple but strong predictor of outcome in patients with acute myocardial infarction. J Am Coll Cardiol 1994; 24:384–91
  9. Barbash GI, Roth A, Hod H, et al. Rapid resolution of ST elevation and prediction of clinical outcome in patients undergoing thrombolysis with alteplase (recombinant tissue-type plasminogen activator): results of the Israeli Study of Early Intervention in Myocardial Infarction. Br Heart J 1990;64:241–7
  10. Anderson RD, White HD, Ohman EM, et al. Predicting outcome after thrombolysis in acute myocardial infarction according to ST-segment resolution at 90 minutes: a substudy of the GUSTO-III trial. Global Use of Strategies to Open occluded coronary arteries. Am Heart J 2002; 144:81–8
  11. Antman EM, Anbe DT, Armstrong P et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarcion— executive summary. Circulation 2004;110:588–636.
  12. Van de Werf F, Ardissino D, Betriu A et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2003;24:28–66.
  13. Anderson RD, White HD, Ohman EM, et al. Predicting outcome after thrombolysis in acute myocardial infarction according to ST-segment resolution at 90 minutes: a substudy of the GUSTO-III trial. Global Use of Strategies to Open occluded coronary arteries. Am Heart J 2002; 144:81–8.
  14. Karthik; Surendran, Satchi A.; A., Mohamed Kasim. Efficacy of thrombolytic therapy with IV streptokinase in acute ST elevation myocardial infarction patients International Journal of Advances in Medicine, [S.l.], v. 6, n. 4, p. 1121-1124, july 2019. ISSN 2349-3933. 

Corresponding Author

Dr Shweta Shinde

Junior Resident, Govt. Medical College, Aurangabad