Comparison of ST-segment resolution influencing in hospital outcome after primary percutaneous coronary intervention and fibrinolysis (with streptokinase) in patients with acute ST-segment elevation myocardial infarction

Abstract

Abstract:Background: Coronary artery disease (CAD) is the most common cause of mortality & morbidity in all over the world. Reperfusion therapy is the cornerstone for treating acute STsegment elevation myocardial infarction. Effective reperfusion in STEMI can be achieved by either fibrinolysis or primary percutaneous coronary intervention (PPCI). PPCI generally produces better outcomes than fibrinolysis but is not widely available. ST-segment abnormalities play a fundamental role in assessment and decision making for patients with STEMI. Methods: This quasi-experimental study was conducted in the Department of Cardiology, National Heart Foundation Hospital and Research Institute. Group I underwent primary PCI and group II received fibrinolytic therapy as reperfusion therapy for acute STEMI. Results: The mean ST-segment resolutions were significantly more in group I than group II at 60 minutes (63.54±20.98 vs 33.97±15.88%, p<0.001) and at 90 minutes (73.15±18.76 vs 60.06 ±23.33%, p<0.015). However, the difference is not significant at 180 minutes after procedure (74.48±18.09 vs 65.33±21.20%, p=0.064). In our study we observed that significantly higher number of patients of group II developed acute LVF (33.3% vs 6.1%, p=0.005) and cardiogenic shock (18.2% vs 3.0%, p=0.046) than group I and Rescue PCI was needed in 5 (15.2%% vs 0%, p=0.020) patients of group II than group I. Conclusion: ST-segment resolution occurs earlier and more completely after Primary percutaneous coronary intervention than fibrinolysis (with Streptokinase) with better in hospital outcome in patients with acute STEMI.

Predictors of myocardial functional recovery following successful reperfusion of acute ST elevation myocardial infarction

“…This study showed that the 90‐minute ST resolution was significantly higher in PPCI group ( P = 0.04), and this is in agreement with Rahman et al who reported that ST‐segment resolutions were significantly more in PPCI than thrombolysis at 90 minutes (73.15 ± 18.76 vs 60.06 ± 23.33%, P < 0.015).…”

Correlation between Left Ventricular Pressure–Strain Loop and Severity in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome and Its Application Value in Short-Term Prognosis Evaluation

“…Clinical methods used for excluding the diagnosis of coronary artery illness include risk factor assessment, electrocardiography (ECG), cardiac biomarker assessment, cardiac nuclear imaging, echocardiography, cardiac magnetic resonance imaging and invasive coronary angiography. These methods have drawbacks, such as invasiveness, radiation injury, resource allocation and low specificity, and impose a heavy economic burden on sufferers [5,6]. Recently, speckle tracking echocardiography (STE) has been used to evaluate coronary stenosis through the frame-by-frame tracking of the speckle echo motion trajectory of myocardial synchronous movement in the region of interest; it can obtain multiple parameters that reflect myocardial mechanical changes in the longitudinal, radial, circumferential and rotational directions, thus enabling evaluating the local and overall mechanical properties of the myocardium [7,8].…”