Reperfusion failure: a study using electrocardiographic criteria

Background: The incidence of ischemic heart disease and myocardial infarction is increasing in developing nations. One measure that consistently improves outcomes in patients with myocardial infarction is early reperfusion. In resource-constrained settings, reperfusion is often achieved with thrombolysis rather than percutaneous coronary intervention. Our study aimed to determine, by using electrocardiographic criteria, the failure rate of reperfusion with thrombolysis by streptokinase in patients presenting to a tertiary hospital in south India. We also aimed to find the factors associated with failure of thrombolysis in the population under study. Methods: Patients diagnosed to have acute myocardial infarction and thrombolysed with streptokinase were taken for the study. Failure of thrombolysis was defined by electrocardiographic criteria as less than 50% resolution in ST segment elevation in the worst affected lead after thrombolysis. Results: Reperfusion with streptokinase had a high rate of failure. Diabetes smoking longer symptom needle time and higher admission rates and blood pressure and heart rates were factors associated with failure. Conclusion: Thrombolysis with streptokinase has a high rate of failure and certain specific factors are associated with reperfusion failure.