THROMBOLYTIC EFFICACY OF STREPTOKINASE IN ELDERLY TYPE 2 DIABETES MELLITUS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION USING ELECTROCARDIOGRAPHIC ST-SEGMENT RESOLUTION

2021 ◽  
pp. 67-70
Author(s):  
Mahendra Pratap ◽  
Somil Verma ◽  
S. L. Mathur
Keyword(s):  
Myocardial Infarction ◽  
Elderly Patients ◽  
Thrombolytic Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
St Elevation Myocardial Infarction ◽  
Diabetic Patients ◽  
Common Location ◽  
St Segment ◽  
St Elevation

Background: Age and diabetes are important prognostic factors in patients with acute ST-elevation myocardial infarction (STEMI) undergoing thrombolysis. In our study we compared the post-thrombolytic effect of streptokinase in elderly diabetic and non-diabetic patients. Methods: A prospective observational study was conducted in tertiary care center of India in which 140 elderly patients diagnosed with STEMI and undergoing thrombolytic therapy with streptokinase were enrolled after making necessary exclusions and were divided into diabetic (n=70) and non-diabetic (n=70) as study and control groups respectively. ECG was done immediately before and at 60 minutes after thrombolytic therapy. ST-segment resolution was measured and patients were classied as failed (<30%), partial (30-70%) and successful (>70%) resolution of STsegment. Results: Failed thrombolysis was evident in 34.3% non-diabetic and 57.1% diabetic patients (p=0.010). The incidence of successful thrombolysis was present in 41.4% non-diabetic and 28.6% diabetic patients, whereas partial thrombolysis was seen in 24.3% non-diabetic and 14.3% diabetics. Anterior wall was the most common location of infarction in elderly population but the proportion was higher in diabetics than non-diabetics (p=0.025). Conclusion: Failed thrombolysis with streptokinase was higher in diabetics than in non-diabetics after 60 minutes of streptokinase infusion in elderly patients warranting the need of using another cost effective and easily available agent for elderly diabetic population.

scholarly journals A Comparative Study of St Segment Resolution between Diabetic and Non-Diabetic ST Segment Elevation Myocardial Infarction Patients following Streptokinase Thrombolysis

2019 ◽  
Vol 11 (2) ◽  
pp. 118-122
Author(s):  
Shahriar Iqbal ◽  
M Saiful Bari ◽  
MA Bari ◽  
Mirza Md Nazrul Islam ◽  
M Abdullah Al Shafi Majumder ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Thrombolytic Therapy ◽  
St Elevation Myocardial Infarction ◽  
Diabetic Patients ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
St Elevation ◽  
Prolong Hospital Stay

Background: One of the most effective and used (in our settings) methods of reperfusion of ST elevation myocardial infarction (STEMI) is administration of streptokinase (SK) infusion. This study was conducted with the aim to compare ST segment resolution between diabetic and non-diabetic patients with ST segment elevation myocardial infarction after thrombolysis by streptokinase. Methods: A total of 100 patients with ST elevation myocardial infarction with or without diabetes mellitus were studied from December 2016 to November 2017. Among these half of patients were diabetic while rests were non-diabetic. Streptokinase was administered to all patients. Resolution (reduction) of elevated ST segment was evaluated after 90 min of streptokinase administration. Results: Failed reperfusion (<30% ST resolution) was significantly higher in diabetic as compared to nondiabetic patients (42% vs. 12%, p <0.001). In hospital complications were more in diabetic patients who has failed reperfusion following streptokinase thrombolysis. Cardiogenic shock occurred in 44% and acute LVF in 30% patients and EF (46.54%) was significantly lower in diabetic patients and higher number of diabetic patients had prolong hospital stay than non-diabetic patients with STEMI. Conclusion: The outcome of thrombolytic therapy is adversely affected by diabetes mellitus in patients with ST-elevation myocardial infarction. Cardiovasc. j. 2019; 11(2): 118-122

scholarly journals Challenges in Timely Pharmacological Reperfusion Therapy of Acute ST-Elevation Myocardial Infarction Patients: A Cross-sectional Study

2021 ◽  
Author(s):  
Prakriti Snehil ◽  
Anwar Hussain Ansari ◽  
Praloy Chakraborty ◽  
Niveditha Devasenapathy
Keyword(s):  
Myocardial Infarction ◽  
Thrombolytic Therapy ◽  
Tertiary Care ◽  
Reperfusion Therapy ◽  
St Elevation Myocardial Infarction ◽  
System Level ◽  
Care Hospital ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
St Elevation

Introduction: Acute ST-Elevation Myocardial Infarction (STEMI) is the most severe presentation of an Acute Coronary Syndrome (ACS) resulting from sudden occlusion of one of the major epicardial coronary arteries resulting in myocardial injury and necrosis within minutes to few hours. Despite Primary Percutaneous Coronary Intervention (PPCI) being the gold standard, thrombolytic therapy is still the most common form of reperfusion therapy in eligible patients of acute STEMI even in large metropolitan cities in India. Aim: To find the proportion of STEMI patients receiving thrombolytic therapy within four hours of the onset of symptoms and within 30 minutes of reaching the hospital and to explore factors related to Pain-To-Door (P2D) delay. Materials and Methods: This was a single-centre cross-sectional observational study of 147 STEMI patients conducted at a tertiary care hospital in the National Capital Territory (India). from February to May 2017. Ethical clearance was obtained from the Institute’s Ethics Committee. All patients were interviewed and their medical records reviewed. Factors related to delay in reaching hospital and association of patient characteristics with those receiving thrombolytic therapy were explored using univariable and multivariable logistic regression. Results: Mean age of the study population was 52.1±13.1 years and 121 (82.3%) were men. Median P2D time was 4.7 hours (IQR- 2.2-17.0). Overall, 64 (43.5%) of 147 patients reached the hospital within four hours of chest pain. Only 5 (3.4%) patients availed ambulance to reach the hospital. Distance from the hospital, seeking care elsewhere and delay in reaction to symptom were reasons for the delay (>4 hours). Median Door-To-Needle (D2N) time was 45.9 minutes (IQR- 30.6-61.2). Patients who reached the hospital at night were more likely to be thrombolysed after adjusting for time to reach the hospital. Conclusion: Significant P2D and Door-To-Balloon (D2B) delays still exist in large metro cities in India. Action is needed both at the population level as well as system level to reduce these delays.

scholarly journals A Comparative Study to Assess the Efficacy of Streptokinase in Diabetic Versus Non-Diabetic Acute ST Elevation Myocardial Infarction Patients

Esculapio ◽  
2021 ◽  
Vol 17 (1) ◽  
pp. 88-92
Author(s):  
Zeeshan Hassan ◽  
Nabeegh Rana ◽  
Bakhtawar Rana ◽  
Asif Iqbal ◽  
Ali Javaid Chughtai
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Comparative Study ◽  
St Elevation Myocardial Infarction ◽  
First Episode ◽  
P Value ◽  
Diabetic Patients ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation

Objective: Prominent resolution in the ST segment elevation on electrocardiogram(ECG), thrombolysis at the infarction site restoring perfusion determines the effectiveness of the streptokinase therapy. Hyper- coagulable states and lack of efficacy with streptokinase is seen in diabetics. This study aimed to assess the thrombolytic efficacy of streptokinase in diabetic vs non-diabetics patients. Methods: A cross-sectional study was conducted at Cardiology Department of Allama Iqbal Memorial Teaching Hospital, Sialkot from 1st September 2019 to 30th April, 2020. Total 504 patients of which 185 diabetics and 319 non-diabetic were selected. All the patients presenting with first episode of acute ST- elevation myocardial infarction were thrombolysed with 1.5million units of streptokinase within 12hours from the onset of their typical chest pain symptoms. A complete record of ECG changes was kept before and 90 min after thrombolysis with streptokinase. Chi- square test was applied and p value <0.05 was considered significant. Results: 89.19% diabetic patients had >70% resolution of ST segment changes in comparison to 95.61% non-diabetics. 16.76% of the diabetic patients had increased ST-segment elevation post thrombolysis (P- value 0.001). 8.11% and 10.81% reinfarction rates during hospital stay and at one month post-thrombolysis were recorded in diabetics. Reduced left ventricle Ejection Fraction was seen in 62.16% and 58.62% of the diabetic and non-diabetic patients(P-value<0.005). Conclusion: Comparatively decreased efficacy of streptokinase is seen in diabetic patients with reduced resolution of ST-segment. In correspondence with reduced left ventricle EF, re-infarction and stroke episodes. Key Words: Streptokinase, acute myocardial infarction, STEMI, diabetes mellitus, hypercoagulability, atherosclerosis. How to Cite: Hassan Z., Rana N., Rana B., Iqbal I., Chughtai J.I. A comparative study to assess the efficacy of streptokinase in diabetic versus non-diabetic acute ST elevation myocardial infarction patients. Esculapio 2021;17(01):88-92

scholarly journals Upper Extremity Dysfunction after Trans-Radial Interventions- Experience from a Tertiary Care Center of North India

2020 ◽  
Author(s):  
Manazir Iqbal ◽  
Mohd Iqbal Dar ◽  
Aamir Rashid ◽  
Khursheed A Khan
Keyword(s):  
Myocardial Infarction ◽  
Upper Extremity ◽  
Care Center ◽  
Tertiary Care ◽  
Vascular Occlusion ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
North India ◽  
Post Procedure ◽  
St Elevation

Introduction: Coronary artery disease treatment by percutaneous intervention has revolutionised the management of this disease and the choice and safety of vascular access site has significantly contributed to the outcome of the overall procedure. Aim: To assess upper extremity dysfunction in patients undergoing Transradial Coronary Angiography (CAG) and Percutaneous Coronary Interventions (PCI). Materials and Methods: This study involved patients planned for transradial coronary intervention. Patients were assessed for development of upper extremity dysfunction and other local complications post procedure at 24 hours, 2 weeks, 1 month and 6 months. Data analysis was done using SPSS Version 21. Results: A total of 165 patients were enrolled in the study. There were 123 (74.5%) males. Total 156 patients (94.5%) had stable angina as underlying diagnosis, 4 (2.4%) had unstable angina, 2 (1.2%) had Non ST Elevation Myocardial Infarction (NSTEMI), 1 (0.6%) had ST Elevation Myocardial Infarction (STEMI) and 2 (1.2%) required CAG before valve replacement. A 5F sheath was used in 110 (66.67%) and 6F sheath in 55 (33.33%) cases. Tiger catheter was used in all 165 patients initially for diagnostic angiography. Dynamometer testing showed reversible downgrading of hand grip in 49% of patients post-procedure. Local site haematoma was seen in 3 (1.8%) at 24 hours, reversible vascular occlusion in 2 (1.2%) at 24 hours and Thrombolysis in Myocardial Infarction (TIMI) Minor bleed in 1 (0.6%) at 24 hours. No significant correlation was seen between sheath or catheter size with dynamometer testing or local complication. Conclusion: There was no significant upper extremity dysfunction after trans-radial intervention in the study population.

scholarly journals Reperfusion times for ST elevation myocardial infarction: a prospective audit

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Kendeep S Kaila ◽  
Kapil M Bhagirath ◽  
Malek Kass ◽  
Lorraine Avery ◽  
Lillian Hall ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Response Times ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Strong Trend ◽  
St Elevation ◽  
Contact Response

Background: New published guidelines recommend treatment of ST elevation myocardial infarction (STEMI) within 30 minutes of first medical contact to thrombolysis and 90 minutes to primary percutaneous coronary intervention (PCI). Objectives: To determine how a tertiary care center compares to these new guidelines and to evaluate the success of measures directed to shorten delays. Methods: This was a prospectively designed audit loop using retrospective chart review. Specific time intervals were evaluated: 1) T2 (ER presentation to diagnostic EKG; 2) T ER (ER presentation to reperfusion); and 3) T AHA (first medical contact to reperfusion). Results of the initial 12-month data were conveyed to Emergency Room staff and a dedicated EKG machine was placed in the ER for the subsequent 12 months, and the results were then re-analyzed. Results: In 2003-4, 58 patients with STEMI were identified, with 41 (70.7%) receiving reperfusion. Of those receiving thrombolysis, median T AHA was 54 [37-72] minutes, with 12.0% <30 minutes, while those receiving PCI, median T AHA was 58 [43-78] minutes, with 25.0% <90 minutes. In 2004-5, 52 patients had STEMI, with 40 (76.9%) receiving reperfusion. The percentage of patients meeting the guidelines was 14.3% for the thrombolysis group and 11.1% for the PCI group. Introduction of a dedicated EKG machine led to a strong trend towards improvement in median T2 (22 vs 10 minutes; P=0.07), but other treatment times remained unchanged. Conclusions: Treatment times are longer than recommended guidelines. More comprehensive strategies and improved coordination of medical services are required to shorten pre-contact and post-contact response times.

scholarly journals Case report and systematic review of pulmonary embolism mimicking ST-elevation myocardial infarction

Vascular ◽  
2018 ◽  
Vol 27 (1) ◽  
pp. 90-97 ◽  
Author(s):  
Pedro A Villablanca ◽  
Peter P Vlismas ◽  
Tatsiana Aleksandrovich ◽  
Arthur Omondi ◽  
Tanush Gupta ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Diagnostic Imaging ◽  
Right Ventricular ◽  
Clinical Presentation ◽  
St Elevation Myocardial Infarction ◽  
Common Location ◽  
St Segment ◽  
Right Ventricular Strain ◽  
St Elevation

Background To study trends in the clinical presentation, electrocardiograms, and diagnostic imaging in patients with pulmonary embolism presenting as ST segment elevation. Methods We performed a systematic literature search for all reported cases of pulmonary embolism mimicking ST-elevation myocardial infarction. Pre-specified data such as clinical presentation, electrocardiogram changes, transthoracic echocardiographic findings, cardiac biomarkers, diagnostic imaging, therapy, and outcomes were collected. Results We identified a total of 34 case reports. There were 23 males. Mean age of the population was 56.5 ± 15.5 years. Patients presented with dyspnea (76.4%), chest pain (63.6%), and tachycardia (71.4%). All patients presented with ST-elevations, with the most common location being in the anterior-septal distribution, lead V3 (74%), V2 (71%), V1 (62%) and V4 (47%). ST-segment elevations in the inferior distribution were present in lead II (12%), III (18%), and aVF (21%). Presentation was least likely in the lateral distribution. Troponin was elevated in 78.9% of cases. Right ventricular strain was the most common echocardiographic finding. Over 80% of patients had findings consistent with elevated right ventricular pressure, with 50% reported RV dilatation and 20% RV hypokinesis. The most commonly used imaging modality was contrast-enhanced pulmonary angiography. There was a greater incidence of bilateral compared to unilateral pulmonary emboli (72.4% vs. 10%). About 65% patients received anticoagulation and 36.3% were treated with thrombolytics. Forty-six percent of patients required intensive care and 18.7% intubation. Overall mortality was 25.8%. Conclusions A review of the literature reveals that in patients presenting with pulmonary embolism, electrocardiogram findings of ST-segment elevations will occur predominantly in the anterior-septal distribution.

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