THROMBOLYSIS IN ST- ELEVATION MYOCARDIALINFRACTION PATIENTS: CLINICAL PREDICTORS OF REPERFUSIONAND ANGIOGRAPHIC OUTCOMES

Background: Thrombolysis is an alternative strategy for reperfusion in the management of ST- Elevation Myocardial Infraction (STEMI) patients, when percutaneous coronary intervention (PCI) cannot be performed. However, using clinical markers of reperfusion, thrombolysis is not always successful for all patients and immediate angiographicrescue PCI is indicated. Aim of the Work: Thegoal of this clinical study was to determinethe angiographic efficacy of thrombolysis in STEMI patients. Besides its correlation in successful or failed thrombolysis (FT) based on clinicalcriteria of reperfusion. Material/Methods: The study population included patients with acute STEMI within 12 hours of onset chest pain, who were admitted to The Cardiac Intensive Care Unit of cardiology department, atUniversityHospital Center Mohammed VI of Marrakech Morocco, receiving thrombolysis with Tenecteplase, during the period from January2021 to January2023. Repeated Electrocardiogram (EKG) at baseline, 90 minutes after Thrombolysis to define FT and PCIwereperformedfor all patients. Results:121 patients with a mean age of 56 years were recruited in the study. Successful thrombolysis was present in 60% of patients (n = 73) in Group I, while 40% of patients (n = 48) had FT in Group II. There was no significant difference between patients in both groups regarding gender, risk factors for coronary artery disease like dyslipidemia, diabetes mellitus, obesity, smoking, and myocardial infraction territory on the EKG. However, hypertension, delayed presentation after six hours of onset chest pain, and severe alteration of the systolic ejection fraction were mostly present in Group II. The TIMI III flow rates represent 76%(n = 93) of the patients in the study, with higher rates in both groups, at 80% versus 70% for groups I and II, respectively. Conclusion: The study confirmed that unsuccessful thrombolysisdoes not mean always-unsuccessful restoring of epicardial coronary flow.As a result, our current results clearly demonstrate the benefits of fibrinolysisfor STEMI patients when resources are limited for primary PCI. However, Additional clinical studies are also needed to investigate the recovery of microvascular and tissular perfusion to improve myocardial function and long-term clinical outcomes.