Survival of patients receiving fibrinolytic therapy for acute ST-segment elevation myocardial infarction in a developing country – patient characteristics and predictors of mortality

Abstract

There is paucity of outcomes data on patients receiving fibrinolytic therapy (FT) for acute ST-elevation myocardial infarction (STEMI) in Indo-Asians. We conducted this study to determine survival as well as correlates of mortality in this population. Hospital charts of 230 patients receiving FT for acute STEMI between January 2002 and December 2004 were reviewed. Primary outcome variable was total mortality. Cox proportional hazards regression models were constructed. At a median follow-up of 717 days, 13.5% died, majority (23) during the in-hospital period. Multivariate predictors of mortality included (adjusted hazards ratio [HR], 95% confidence interval [CI]) age (HR 1.06, 95% CI 1.01-1.13), ejection fraction (HR 0.93, 95% CI 0.89-0.97), admission white cell count (HR 1.02, 95% CI 1.01-1.04) and change in ST-segment elevation (HR 0.96, 95% CI 0.92-0.99). We conclude that patients receiving FT for acute STEMI in Pakistan are a relatively high-risk group with a 10% in-hospital mortality and high frequency of recurrent events. Comparison data with primary angioplasty as an alternative strategy are needed.

Early and long term outcome of rescue percutaneous coronary intervention (R-PCI): experience from a tertiary care center in Pakistan

“…Stenting during rescue PCI has been independently associated with improved immediate angiographic results and greater myocardial salvage compared with angioplasty alone [22][23][24]. A recent study by Jafary et al [25], from our institution evaluated the outcomes of patients undergoing fibrinolytic therapy over the same period of time as this study. 230 patients with STEMI receiving fibrinolytic therapy between January 2002 and December 2004 were reviewed.…”

“…At a median follow-up of 717 days 31 (13.5%) patients died with the majority 23 (10%) during the in-hospital period. Age, LVEF, WBC count on admission and failure of ST segment resolution were independent predictors of death on multivariate analysis [25]. During the study period our hospital received 250 patients with STEMI/year on an average, out of which approximately 30% underwent primary PCI.…”

Fibrinolytic therapy use for ST-segment elevation myocardial infarction and long-term outcomes in China: 2-year results from the China Acute Myocardial Infarction Registry

“…Although primary percutaneous coronary intervention (PCI) has replaced fibrinolysis as the preferred reperfusion strategy in the current management of ST-segment elevation myocardial infarction (STEMI) [ 1 , 2 ], the latter is still the mainstay in regions with challenging geography and limited healthcare provision, particularly in developing countries [ 3 – 9 ]. However, compared with detailed reports of fibrinolysis utilization and clinical outcomes in treated patients in developed countries [ 10 – 12 ], the management and prognosis of fibrinolytic-treated patients in developing countries have been previously investigated in either randomized trials, which might not be representative of real world clinical practice [ 13 , 14 ], or in registry studies that either restricted to examining modest-sized cohorts [ 15 ], a single-center design [ 15 , 16 ], or relatively short-term follow-up [ 6 , 16 , 17 ]. Furthermore, most of them were performed in the era preceding the use of current adjunctive antiplatelet therapy [ 13 – 17 ].…”