Volume : IX, Issue : VIII, August - 2020

THE ASSESSMENT OF EFFICACY OF LATE THROMBOLYSIS IN ACUTE MYOCARDIAL INFARCTION

Nikhitha K. , Lalitha Kumari V.

Abstract :

Background: Thrombolytic therapy is effective when given as early as possible after acute myocardial infarction (AMI). However, greater than 30% of AMI patients will come to hospital 6 hours after the onset of their first symptom i.e., later than the usual time window for administration of thrombolytic therapy. Thus, extension of this time window to patient presenting up to 24 hours after the symptom onset will make such therapy available to more patients. Objective: To assess the efficacy of late thrombolysis (7–24 hours) in AMI patients with regard to relief of symptoms, rapid ST–elevation resolution on treatment, mortality and left ventricular function, in–hospital and on 1 month, 6 months and 1 year follow–up. To compare the late thrombolyzed group with early thrombolyzed and non–thrombolyzed group. Method: A total of 159 consecutive patients at their first episode of AMI presenting within 24 hours from the chest pain onset are included in the study. Once diagnosis of STEMI made and thrombolytic therapy was given, all patients were categorized into 4 groups. First 3 groups received thrombolytic therapy with 1.5 million IU of streptokinase in 100 ml of normal saline over 45 minutes, categorized on duration from onset of chest pain to administration of thrombolytic therapy and the fourth group included non–thrombolyzed patients. Group–I 0 to 6 hours (74 patients) – 46.50% Group–II 7 to 12 hours (38 patients) – 23.90% Group–III 13 to 24 hours (18 patients) – 11.30% Group–IV Non–thrombolyzed group (28 patients) – 18.20% Thus, 56 patients (35.2%) belonged to late thrombolyzed group (7–24 hours) In–hospital complications and mortality were followed up in all patients, left ventricular function was assessed by 2D Echo before discharge. Patients who survived initial hospitalization were followed up for mortality and left ventricular function at 1 month, 6 months and 1 year during the study period. Results: After thrombolytic therapy, rapid relief in chest pain was noted in 49 patients (66.21%) of 0–6 hours, 18 patients (47.36%) of 7–12 hours and 6 patients (33.33%) of 13–24 hours group and 7 patients (24.13%) in the non–thrombolyzed group after routine coronary care treatment. Rapid resolution of ST elevation was seen in 36 patients (48.64%) of 0–6 hours, 13 patients (34.2%) of 7–12 hours, 4 patients (22.22%) of 13–24 hours and 5 patients of non–thrombolyzed (17.24%). Persistent hypotension, left ventricular failure, cardiogenic shock, asystole, complete heart block occurred less in late thrombolyzed group compared to non–thrombolyzed group except for ventricular tachycardia. Cardiogenic shock and ventricular tachycardia occurred more frequently in early thrombolyzed group than late thrombolyzed group. In–hospital mortality was 11 (14.86%) in 0–6 hours, 2 (5.26%) in 7–12 hours, 5 (27.77%) in 13–24 hours and 7 (12.5%) in combined late thrombolyzed group (7–24 hours) as compared to 7 deaths (24.3%) in non–thrombolyzed group. Regional wall motion abnormality, systolic dysfunction of left ventricle occurred less in late thrombolyzed group as compared to non–thrombolyzed group but was more than early group. No statistically significant difference in ejection fraction was noted in any of the group before discharge. One month follow up was done in 110 patients out of 134 patients who survived initial hospitalization. There was 1 death in 0–6 hours group, 1 in 13–24 hours group and 1 in non–thrombolyzed group. At 6 months, 93 out of 99 patients were followed up. There were 2 deaths each in 7–12 hours group and non–thrombolyzed group. At 1 year, 40 out of 48 patients were followed up. There was 1 death in 7–12 hour group. Mortality and left ventricular function could not be compared between any of the groups on follow up as the number of patients differed because some of the patients from each group did not turn up for follow–up. Conclusion: Though thrombolytic therapy is most effective when given early, late treatment is also beneficial. Efforts should continue to administer thrombolytic therapy at the earliest possible and treatment should not be denied in those who presented late.

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Article: Download PDF    DOI : 10.36106/ijsr  

Cite This Article:

THE ASSESSMENT OF EFFICACY OF LATE THROMBOLYSIS IN ACUTE MYOCARDIAL INFARCTION, NIKHITHA K., LALITHA KUMARI V. INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : Volume-9 | Issue-8 | August-2020

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