Clinical profile and mortality of ST-Segment elevation myocardial- infarction patients receiving thrombolytic -Therapy in the Middle East

Abstract

Objective: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.

Effectiveness and comparison of reteplase versus streptokinase thrombolytic agents in the patients of acute myocardial infarction

“…[4][5][6] In a study comparing the efficacy of thrombolytics in AMI patients, revealed the significantly lower mortality in the patients thrombolysed by reteplase as comparing to streptokinase at 1-year post-AMI follow-up. [7] Above finding is consistent with the present study, in which a significantly lower mortality rate (χ 2 = 3.96, d.f. = 1, P = 0.0466) was observed in the patients of reteplase as compared to streptokinase at 1-year post-AMI follow-up.…”

Reduction in Door-to-Needle Time after Transfer of Thrombolysis Site from CCU to Emergency Department

“…This result was much better than the results reported in previous studies [4–6, 8, 10, 11, 13–15]. Although the DNT reduction was highly significant, there was no significant reduction in hospitalization days or mortality among either of the groups which is similar to what was found in some previous studies [4, 8, 14], while the analysis by the myocardial infarction triage and intervention trial showed a 7-fold reduction of 30 day mortality in patients treated within 70 minutes [22].…”

Intracranial haemorrhage 4 days after receiving thrombolytic therapy in a young woman with myocardial infarction

“…Tenecteplase (TNK-tPA) is the easiest fibrinolytic to use (it can be given as a single bolus), and in ASSENT-2 trial it was associated with a significantly lower rate of non-cerebral bleeding complications and the need for transfusions compared to reteplase. However, there was no much difference in the rate of intracerebral haemorrhage when compared to alteplase or reteplase 12 13. Tenecteplase is the fibrinolytic agent of choice in many hospitals 14…”