Impact of type of thrombolytic agent on in-hospital outcomes in ST-segment elevation myocardial infarction patients in the Middle East (original) (raw)
Related papers
Heart Views, 2012
Little is known about thrombolytic therapy patterns in patients with ST-elevation myocardial infarction (STEMI) in the Middle East. The objective of this study was to evaluate the clinical profile and mortality of STEMI patients who arrived in hospital within 12 hours from pain onset and received thrombolytic therapy. Patients and Methods: This was a prospective, multinational, multi-centre, observational survey of consecutive acute coronary syndrome patients admitted to 65 hospitals in six Middle Eastern countries during the period between October 2008 and June 2009, as part of Gulf RACE-II (Registry of Acute Coronary Events). Analyses were performed using univariate statistics. Results: Out of 2,465 STEMI patients, 66% (n = 1,586) were thrombolysed with namely: streptokinase (43%), reteplase (44%), tenecteplase (10%), and alteplase (3%). 22.7% received no reperfusion. Median age of the study cohort was 50 (45-59) years with majority being males (91%). The overall median symptom onset-to-presentation and door-to-needle times were 165 (95-272) minutes and 38 (24-60) minutes, respectively. Generally, patients presenting with higher GRACE risk scores were treated with newer thrombolytic agents (reteplase and tenecteplase) (P < 0.001). The use of newer thrombolytic agents was associated with a significantly lower mortality at both 1-month (0.8% vs. 1.7% vs. 4.2%; P = 0.014) and 1-year (0% vs. 1.7% vs. 3.4%; P = 0.044) compared to streptokinase use. Conclusions: Majority of STEMI patients from the Middle East were thrombolysed with streptokinase and reteplase in equal numbers. Nearly one-fifth of patients did not receive any reperfusion therapy. There was inappropriately long symptom-onset to hospital presentation as well as door-to-needle times. Use of newer thrombolytic agents in high risk patients was appropriate. Newer thrombolytic agents were associated with significantly lower mortality at 1-month and 1-year compared to the older agent, streptokinase.
International Journal of Clinical Pharmacy, 2012
Background Little is known about predictors and outcome differences of primary percutaneous coronary intervention (PPCI) and thrombolytic therapy (TT) in STsegment elevation myocardial infarction (STEMI) patients in the Middle East. Objective To compare predictors as well as in-hospital outcomes of PPCI and TT in STEMI patients in six Middle Eastern countries. Setting Sixty-five hospitals (covering at least 85 % of the population) in Oman, United Arab Emirates, Qatar, Bahrain, Kuwait and Yemen. Methods This was a prospective, multinational, multicentre, observational survey of consecutive acute coronary syndrome patients who were admitted to 65
Thrombolytic therapy use for acute myocardial infarction and outcome in Qatar
International Journal of Cardiology, 2005
Objective: Data on the outcome of patients treated with thrombolytic therapy in the Arab world is scarce. The main objective of this study is to study the 7-day morbidity and mortality rate and the rate of use of thrombolytic therapy in patients presenting with acute myocardial infarction treated with thrombolytic therapy in the Middle East. Methods: We conducted a retrospective analysis of prospectively collected data for all patients who were admitted to Coronary Care Unit in Cardiology Department in Hamad Medical during the period (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001). Patients were divided into two groups in relation to ethnicity whether they received thrombolysis or not. In each group, the number of patients, age at the time of admission, gender, cardiovascular risk profile, therapy and outcome in regard of in-hospital complication and 7-day death as primary end point were analyzed. Results: Of the total 5388 patients admitted with acute myocardial infarction during the 10-year period, 66.3% (3567) with STE MI were found, 61.4% (2190) of them received thrombolytic therapy while 38.6% (1377) were not eligible for thrombolytic therapy. The remaining 33.7% (1821) were admitted with non-STE MI. In consideration of ethnic variation, patients with STE MI eligible for thrombolytic therapy, 29.6% (1598) were Qataris and 70.4% (3792) were non-Qataris. Thrombolytic therapy was administered to 25.9% (414) of Qatari patients and 51.3% (1947) of non-Qataris. The mortality rate of Qatari patients who received thrombolytic therapy was 9.2% (38) vs. 19.5% (231) who did not receive thrombolytic therapy ( pb0.001). In non-Qatari patients, the mortality rate was 5.2% (102) for those who received thrombolytic therapy, while it was 8.6% (159) for those with no thrombolytic therapy ( pb0.001). When compared to male patients, female patients with thrombolytic therapy had higher mortality rates (in both Qataris and non-Qataris) (20.5% vs. 6.1%; p valueb0.001 and 16.1% vs. 9.4%; pb0.001, respectively), there were no significant differences between the ethnic groups in regard to in-hospital complications. Patients treated with thrombolytic therapy had lower incidence of in-hospital complication regarding acute heart failure, post-myocardial angina, heart block and arrhythmia. Thrombolytic therapy reduced mortality rate in acute myocardial infarction by 69%. Logistic regression analysis had shown that arrhythmia, acute heart failure, heart block, cardiogenic shock, diabetes mellitus and stroke were independent predictors of increased mortality. Thrombolysis was used in 61.4%, which is still underutilized when compared to a few available studies in the Gulf area, and to other studies in the developed world.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 1997
To characterize the extent of delay in administration of thrombolytic therapy to patients with acute myocardial infarction (AMI) in Canada, to examine patient-specific predictors of such delay and to measure the effect of delay on short-term nonfatal cardiac outcomes. Secondary cohort analysis of data from the first international Global Utilization of Streptokinase and tPA for Occluded Coronary Arteries (GUSTO-I) trial. Sixty-three acute care hospitals across Canada. All 2898 Canadian patients with an AMI enrolled in GUSTO-I. Time before arrival at a hospital ("symptom-to-door" time) and time from arrival to administration of therapy ("door-to-needle" time) for patients who had an AMI outside of a hospital, in clinically relevant categories; proportions of patients with nonfatal, serious cardiac events, including shock, sustained ventricular tachycardia, ventricular fibrillation and asystole. Of the total number of patients enrolled, records were complete for 270...
The immediate outcome of thrombolytic therapy in ST-elevation myocardial infarction Medical Science
2020
Background: Plaque rupture and thrombus development play a major role in the genesis of acute coronary occlusion. The introduction of thrombolytic therapy was the main advance in the management of acute ST-elevation myocardial infarction (STEMI) since over 90 percent of such patients have complete occlusion of the culprit artery. Due in part to insufficient availability of primary PCI, fibrinolysis persists a vital therapeutic option. The earlier reperfusion occurs, the greater the benefit that can be achieved. The survival rate is elevated when thrombolytic drugs are prescribed within the first 4 hours after the onset of symptoms, especially, ANALYSIS ARTICLE ANALYSIS within the first seventy minutes. Objective: To evaluate the immediate effect of fibrinolytic therapy in patients admitted to the coronary care unit with acute myocardial infarction. Methods: A retrospective study was carried out at Baghdad Teaching Hospital/ cardiac care unit (CCU) during the period from June 2018-January 2019. All patients with chest pain with confirmed ST-elevation MI were included (40) patients.The patients divided into two groups: Group no.1 patients receive thrombolytic therapy within a period less than three hours from onset of chest pain, Group no. 2 patients receive thrombolytic therapy within a period between three hours to twelve hours from onset of chest pain. Result: A total of 40 patients who were presented with STEMI were included in this study. The patients were 31(77.5%) males and 9 (22.5%) were females. The mean age was 61.27 ± 9.47. There was a statistically significant relationship between risk factors, diabetes mellitus (P=0.004), ischemic heart disease (P= 0.029), hypertension (P=0.003), gender (P=0.011), and alcohol (P=0.033) and the occurrence of Acute myocardial infarction (AMI) and the impact of time to thrombolytic medication on outcome in patients with acute myocardial infarction. Statistical significant between thrombolytic administration and the basal crackle as a complication (P= 0.011) as a result of delay the time to delivery of fibrinolytic therapy. Conclusion: The most important factor in determining outcomes in patients who present with a STEMI is the time taken from onset to reperfusion. The little risk for dying through acute hospitalization period was seen for those treated with tissue plasminogen activator within two hours of acute symptoms. Elderly, women, hypertensive, and diabetic patients had longer delays at all stages. Prior infarction was an added risk factor for treatment delay.
Zanjan University of Medical Sciences, 2022
Background and Objective: Acute myocardial infarction (MI) is caused due to coronary artery occlusion and divided into two forms of ST-elevation (STEMI) and non-ST-elevation (NSTEMI) myocardial infarction. This study aimed to determine the success rate of treatment with primary PCI (percutaneous coronary intervention) versus thrombolysis in the establishment of perfusion and to evaluate the short-term complications caused by each method. Materials and Methods: In this prospective cohort study, 90 patients were selected for primary PCI treatment and 90 patients for thrombolytic treatment. Clinical data and basic demographic characteristics of the patients and cardiovascular risk factors were recorded. The success rate of coronary reperfusion by primary PCI and thrombolytic therapy was then determined by angiography and 90-minute ECG with resolution or improvement of chest pain. All patients were examined for any serious complications such as cerebrovascular accidents, shock, and heart failure for 30 days after treatment. Data were analyzed using SPSS ver. 20. Results: In the primary PCI group, 75.6% of the patients were males, and 24.4% were females, but in the thrombolytic group, 76.6% and 23.3% of the cases were males and females, respectively. The mean door-to-balloon time for PCI was 63.60 ± 23.92 and was 53.70 ±21.52 min in the thrombolytic group. Thrombolysis in myocardial infarction (TIMI) flow grade III and TIMI-II were the most frequent in primary PCI and thrombolytic groups, respectively. The odds ratio (OD) of mechanical MI and major arrhythmia in patients received the primary PCI compared to those received thrombolytic therapy was 0.24 and 0.66, respectively. Also, the OD of mortality in the primary PCI group was 2.12. Conclusion: Our findings suggest that in STEMI patients, the chances of short-term complications such as post-MI mechanical complications, major arrhythmia, and bleeding requiring blood transfusion were lower in patients who were treated with primary PCI than those who received thrombolytic treatment. Also, the average hospitalization in CCU and hospital in the primary PCI group was lower than the thrombolytic group. Keywords: Primary PCI, Thrombolytic, Fibrinolysis, ST-Elevation Myocardial Infarction (STEMI)
The American Journal of Medicine, 1996
The aim of this study was to determine the proportion of patients with acute myocardial infarction (AMI) excluded from thrombolytic therapy on a national basis and to evaluate the prognosis of these patients by reasons of ineligibility and according to the alternative therapies that they received during hospitalization. PATIENTS AND METHODS: During a national survey, 1,014 consecutive patients with AMI were hospitalized in all the 25 coronary care units operating in Israel. RESULTS: Three hundred and eighty-three patients (38%) were treated with a thrombolytic agent and included in the GUSTO study. Ineligible patients for GUSTO were treated: (1) without any reperfusion therapy (n = 449), (2) by mechanical revascularization (n-97), or (3) given 1.5 million units of streptokinase (n-85) outside of the GUSTO protocol. The inhospital and 1-year post-discharge mortality rates were 6% and 2% in patients included in the GUSTO study; 6% and 5% in those mechanically reperfused; 15% and 10% in those treated with thromoblysis despite ineligibility for the GUSTO trial, and 15% and 13% among patients not treated with any reperfusion therapy. CONCLUSIONS: Ineligibility for thrombolysis among patients with AMI remains high. Patients ineligible for thrombolysis according to the GUSTO criteria, but nevertheless treated with a thrombolytic agent were exposed to an increased risk.
Journal of The American College of Cardiology, 2010
Background: Lack of timely reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) has been associated with worse outcomes. The aim of this study is to identify the frequency and predictors of delayed presentation and missed reperfusion in patients with STEMI in the Gulf Register of Acute Coronary Events (Gulf RACE) registry. Delayed Presentation and missed reperfusion is associated with increased in hospital mortality in STEMI patients. Methods: Gulf RACE is a prospective, multinational study of all consecutive patients hospitalized with the final diagnosis of acute coronary syndrome in 65 centers in 6 Arab countries. In this analysis, we included 3197 patients with STEMI. The independent predictors of delayed presentation and missed reperfusion therapy were identified using multivariate logistic regression. Results: In total, 929 patients presented >12 hours after symptom onset. The independent predictors of late presentation are older age, atypical symptoms, no family history of coronary artery disease, and being in Yemen. Of the 2268 STEMI patients presenting early, a total of 205 patients (9.3%) did not receive reperfusion therapy despite no contraindications (shortfall). The independent predictors of not receiving appropriate reperfusion therapy are older age, prior stroke, being in Yemen, and atypical symptoms. Lack of reperfusion therapy due to shortfall or delayed presentation was associated with increased in-hospital mortality. Conclusions: Nearly one-third of patients with STEMI in the Arab Middle East present to the hospital >12 hours after symptom onset, and nearly 1 in 10 eligible patients do not receive any reperfusion therapy. Community and physician awareness programs are needed to increase the utilization of appropriate lifesaving therapies.