Thrombolysis failure with streptokinase in acute myocardial infarct using ECG criteria - HUSM experience

Streptokinase has high thrombolysis failure rate despite being cheap and widely used in acute myocardial infarction. Electrocardiogram criteria using more than 50% reduction in ST elevation in the worst infarct lead predicted TIMI Ill flow with good sensitivity and specificity. The primary objec...

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Main Author:	Yeh, Lee Yeong
Format:	Thesis
Language:	English
Published:	2006
Subjects:	RC666-701 Diseases of the circulatory (Cardiovascular) system
Online Access:	http://eprints.usm.my/47413/1/Thrombolysis%20Failure%20With%20Streptokinase%20In%20Acute%20Myocardial%20Infarct%20Using%20ECG%20Criteria-HUSM%20Experience...2006...mka..-24%20pages.pdf
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spelling	my-usm-ep.474132020-09-29T04:16:30Z Thrombolysis failure with streptokinase in acute myocardial infarct using ECG criteria - HUSM experience 2006-12 Yeh, Lee Yeong RC666-701 Diseases of the circulatory (Cardiovascular) system Streptokinase has high thrombolysis failure rate despite being cheap and widely used in acute myocardial infarction. Electrocardiogram criteria using more than 50% reduction in ST elevation in the worst infarct lead predicted TIMI Ill flow with good sensitivity and specificity. The primary objective of this study was to determine the failure rate of thrombolysis with streptokinase in acute myocardial infarction using electrocardiogram criteria in Hospital Universiti Sains Malaysia (HUSM). The secondary objective was to compare the association between independent variables, treatment and outcome parameters with failure of thrombolysis with streptokinase. A total of 192 subjects were recruited into this retrospective cohort observational study. 109 patients (56.8%) has failed thrombolysis with streptokinase. Seven variables were significantly associated with thrombolysis failure using streptokinase in a univariate analysis including anterior location of myocardial infarct (p<0.001 ), longer symptom-to-needle time (p=0.01 ), longer door-to-needle time (mean 114 ± 82.9 min, p=0.03), history of hypertension (p=0.04), higher heart rate (mean 79.3 ± 18.3 beats per min, p=0.01 ), higher systolic blood pressure (mean 136.7 + 28.9 mmHg, p=0.02) and higher diastolicblood pressure (mean 83.8 .± 20.9 mmHg, p=0.003). Five variables were associated with streptokinase failure as thrombolytic agent in multiple logistic regression analysis (backward stepwise method) including anterior location of myocardial infarct (p<0.001; OR 0.07, 95% Cl 0.03 - 0.16), longer door-to-needle time (p=0.02; OR 1.01, 95% Cl 1.00 - 1.02), diabetes mellitus (p=0.03; OR 3.13, 95% Cl 1.13 - 8.69), hypertension (p=0.08; OR 2.06, 95°/o Cl 0.92 - 4.60) and high total white cell count (p=0.03; OR 1.12, 950fc, Cl 1.01 - 1.24). Both recurrent acute coronary syndrome (p=0.02; crude OR 2.49, 95o/o Cl 1.16 - 5.32) and death after one year (p= 0.04; crude OR 7.61, 95°/o Cl 0.95 - 61.24) were associated with increase in the rate of thrombolysis failure with streptokinase in univariate analysis. In conclusion, the result of this study has shown that streptokinase has higher failure rate of thrombolysis in acute myocardial infarction using electrocardiogram criteria in HUSM. History of diabetes mellitus, history of hypertension, anterior location of myocardial infarction, longer door-to-needle time and high total white cell count were highly predictive of increase in the rate of thrombolysis failure using streptokinase. This group of patients may benefit from other early reperfusion strategy including tissue plasminogen activators (tPA), PCI or CABG. 2006-12 Thesis http://eprints.usm.my/47413/ http://eprints.usm.my/47413/1/Thrombolysis%20Failure%20With%20Streptokinase%20In%20Acute%20Myocardial%20Infarct%20Using%20ECG%20Criteria-HUSM%20Experience...2006...mka..-24%20pages.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	RC666-701 Diseases of the circulatory (Cardiovascular) system
spellingShingle	RC666-701 Diseases of the circulatory (Cardiovascular) system Yeh, Lee Yeong Thrombolysis failure with streptokinase in acute myocardial infarct using ECG criteria - HUSM experience
description	Streptokinase has high thrombolysis failure rate despite being cheap and widely used in acute myocardial infarction. Electrocardiogram criteria using more than 50% reduction in ST elevation in the worst infarct lead predicted TIMI Ill flow with good sensitivity and specificity. The primary objective of this study was to determine the failure rate of thrombolysis with streptokinase in acute myocardial infarction using electrocardiogram criteria in Hospital Universiti Sains Malaysia (HUSM). The secondary objective was to compare the association between independent variables, treatment and outcome parameters with failure of thrombolysis with streptokinase. A total of 192 subjects were recruited into this retrospective cohort observational study. 109 patients (56.8%) has failed thrombolysis with streptokinase. Seven variables were significantly associated with thrombolysis failure using streptokinase in a univariate analysis including anterior location of myocardial infarct (p<0.001 ), longer symptom-to-needle time (p=0.01 ), longer door-to-needle time (mean 114 ± 82.9 min, p=0.03), history of hypertension (p=0.04), higher heart rate (mean 79.3 ± 18.3 beats per min, p=0.01 ), higher systolic blood pressure (mean 136.7 + 28.9 mmHg, p=0.02) and higher diastolicblood pressure (mean 83.8 .± 20.9 mmHg, p=0.003). Five variables were associated with streptokinase failure as thrombolytic agent in multiple logistic regression analysis (backward stepwise method) including anterior location of myocardial infarct (p<0.001; OR 0.07, 95% Cl 0.03 - 0.16), longer door-to-needle time (p=0.02; OR 1.01, 95% Cl 1.00 - 1.02), diabetes mellitus (p=0.03; OR 3.13, 95% Cl 1.13 - 8.69), hypertension (p=0.08; OR 2.06, 95°/o Cl 0.92 - 4.60) and high total white cell count (p=0.03; OR 1.12, 950fc, Cl 1.01 - 1.24). Both recurrent acute coronary syndrome (p=0.02; crude OR 2.49, 95o/o Cl 1.16 - 5.32) and death after one year (p= 0.04; crude OR 7.61, 95°/o Cl 0.95 - 61.24) were associated with increase in the rate of thrombolysis failure with streptokinase in univariate analysis. In conclusion, the result of this study has shown that streptokinase has higher failure rate of thrombolysis in acute myocardial infarction using electrocardiogram criteria in HUSM. History of diabetes mellitus, history of hypertension, anterior location of myocardial infarction, longer door-to-needle time and high total white cell count were highly predictive of increase in the rate of thrombolysis failure using streptokinase. This group of patients may benefit from other early reperfusion strategy including tissue plasminogen activators (tPA), PCI or CABG.
format	Thesis
qualification_level	Master's degree
author	Yeh, Lee Yeong
author_facet	Yeh, Lee Yeong
author_sort	Yeh, Lee Yeong
title	Thrombolysis failure with streptokinase in acute myocardial infarct using ECG criteria - HUSM experience
title_short	Thrombolysis failure with streptokinase in acute myocardial infarct using ECG criteria - HUSM experience
title_full	Thrombolysis failure with streptokinase in acute myocardial infarct using ECG criteria - HUSM experience
title_fullStr	Thrombolysis failure with streptokinase in acute myocardial infarct using ECG criteria - HUSM experience
title_full_unstemmed	Thrombolysis failure with streptokinase in acute myocardial infarct using ECG criteria - HUSM experience
title_sort	thrombolysis failure with streptokinase in acute myocardial infarct using ecg criteria - husm experience
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2006
url	http://eprints.usm.my/47413/1/Thrombolysis%20Failure%20With%20Streptokinase%20In%20Acute%20Myocardial%20Infarct%20Using%20ECG%20Criteria-HUSM%20Experience...2006...mka..-24%20pages.pdf
_version_	1747821772599721984

Thrombolysis failure with streptokinase in acute myocardial infarct using ECG criteria - HUSM experience

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