Comparison of Thrombolysis Outcome in Early and Late Thrombolysis in Acute STEMI Patients

Introduction: ?A short distance from its origin, the left coronary artery was completely obstructed by a red thrombus that had formed at a point of great narrowing?The hope for the damaged myocardium lies in the direction of securing a supply of blood?(James B Herrick. 1912.) Acute myocardial infarction is usually due to disruption of an atherosclerotic plaque in a coronary artery followed by thrombus formation. The complete occlusion of the lumen of a major epicardial coronary artery leads to acute ST ? Elevation Myocardial Infarction (STEMI). Prompt, complete and sustained restoration of antegrade flow in the infarct related artery is essential to salvage the myocardium at risk, improve ventricular function and reduce short term morbidity and mortality.[1] Thrombolytic therapy for acute myocardial infarction reduces case fatality and improves clinical outcomes.[6,7] The thrombolytic agent available for clinical outcome in our study is streptokinase. 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: In our study 148 males were admitted while 52 were females showing male predominance in acute STEMI. Maximum number of patients (26.5%) were from age group 61-70 yrs. The outcome of therapy showed that 18 % patients of STEMI were died and 82 % were discharged from hospital About the complication after receiving thrombolytic therapy 37 % were in cardiogenic shock, 27.5 % land up in CCF, 15% showed arrhythmias, 12.5 % were having Post infarction angina and very few patients 4.5 % having reinfarction and bleeding 2.5%. most of cases 85 (42.5 %)ST segment resolution larger than 50% were seen where there is initiation of therapy before 6 hours, whereas only 41 (20.5%) of cases shows improve ST segment larger than 50% after 6 hours of initiation of therapy. Conclusion: Complications like cardiogenic shock, CCF were significantly less in patients thrombolysed within 6 hours of onset of chest pain compared to those who thrombolysed after 6 hours, however no difference in death rate was observed in both groups. Patients who were thrombolysed earlier had better ST segment resolution and better outcome than who were thrombolysed later.