In-Hospital Outcome of Acute Myocardial Infarction in patients receiving Streptokinase

Abstract

Objective: To study and compare the in-hospital mortality due to acute myocardial infarction in patients receiving thrombolytic (streptokinase) therapy versus those who were not thrombolysed. Methods: This descriptive observational study was conducted at the Coronary care Unit and Cardiology ward of Nishtar Hospital, Multan, from 1St of October 2002 till 30th of April 2003. Four hundred and thirty four patients of acute myocardial infarction who fulfilled WHO criteria of acute myocardial infarction were included in the study. Patients were divided into two groups: patients receiving streptokinase (SK) group and patients not receiving streptokinase (Non-SK) group. In-hospital mortality was our primary endpoint. Mechanical and electrical complications occurring in-hospital after acute myocardial infarction were secondary endpoints. Results: Only 47% patients received streptokinase while 53% did not receive it because of delayed presentation or some other contraindication to streptokinase therapy. Mean age of the SK group was 51.58±11.02 years and Non-SK group was 55.78±10 years. In SK group 170(83.3%) patients were males and 34(16.7%) were females. Only 54(26.5%) diabetics and 150(73.5%) non-diabetics received streptokinase. Streptokinase recipients reached the hospital earlier; mean time of onset of symptoms till arrival at the hospital was 4 hours and 25 minutes while non-recipients took a longer time in reaching to the hospital. There was no significant difference in the infarct territory between the two groups. The Non-SK group had higher Killip class as compared to SK group on presentation to the hospital. In-hospital mortality was 8.3% in SK group and 24.3% in Non-SK group p<0.0001); left ventricular failure occurred more frequently in Non-SK group and was the most common cause of death in both the groups (p<0.0001 ). Only 4.3% patients in the SK group and 19.6% patients in the Non-SK group died in first 24 hours of hospital admission (p<0.0001 ). Mechanical complications occurred more frequently in Non-SK group (p<0.008). There was a statistically non-significant difference (p<0.436) noted in comparison of electrical complications between the two groups. Conclusions: Streptokinase infusion given in the early hours of acute myocardial infarction leads to a significant reduction in in-hospital mortality and mechanical complications like left ventricular failure.