Influence of various factors on Response to Streptokinase therapy for acute myocardial Infarction

Document Type : Research Paper

Authors

1 Professor of Cardiology, Mashhad University of Medical Science,Mashhad, Iran

2 Cardiologist,Mashhad University of Medical Sciences,Mashhad, Iran

3 Associate Professor of Biostatistics,Mashhad University of Medical sciences,Mashhad, Iran

Abstract

Introduction
 
Prevalence of ischemic heart diseases, especially acute myocardial infarction and its incidence in lower age has increased and treatment during the acute phase of myocardial infarction plays an important role in the prognosis and quality of life. In our study, we aimed to evaluate the effects of streptokinase on treatment of acute myocardial infarction based on different variables.
Materials and Methods
In our study, we evaluated patients with acute myocardial infarction who received streptokinase. Information obtained from patients based on patient examination, ECG findings (before and after drug administration) and the results of relevant laboratory tests, then entered in the relevant checklist. Criteria for response to drug were reduced chest pain with at least 50 percent reduction in ECG ST Elevation in electrocardiography taken 30 or 90 minutes after the Streptokinase therapy
Results
Relation between age (P<0.001), LDL (0.001), diabetes mellitus (P=0. 01), location of MI (P=0.001), Killip Class (P<0.001), patients referring delay (P<0.001) and the effect of streptokinase were significant. While gender, hypertension, smoking, previous ischemic heart disease, time of symptoms onset and type of streptokinase didn’t affect significantly the response to streptokinase.
Conclusion
Considering our results, patients with acute MI less than 30 years and more than 80 years, diabetics, LDL more than 100mg/dl, extensive anterior MI, new LBBB, Killip Class 3 or 4 and delay of referring more than 12 hours predict poor response streptokinase, and may benefit more from early invasive strategy than thrombotic therapy.

Keywords


1- Elliott M.ST elevation myocardial intarction : management. In: Braunwald E, Libby p, Bonow R, Zipes DP, editors.
Braunwald's Heart disease. 8 th ed. Philadelphia: Elsevier Saunders; 2007.p. 1233-1251.
2- Barbash GI , white HD , modan M , Diaz R. Significance of smoking in patients receiving thrombolytic therapy for
acute mI. Circulation 1993; 87: 297-299.
3- Barbash GI, withe HD , modan M, Diaz R, Hampton JR, Heikkila J, et al. Acute mI in young – the role of smoking.
Eur Heart J 1995; 16: 295-296.
4- Kharash Lm , Gol’dkhammer EI. Thrombolytic therapy for acute myocardial infarction: circadian sensitivity. Ter
Arkh 1999; 71:13-17.
5- kharash LM , Gol’dkhammer EI, Abinader EC. The clinical aspects of thrombolytic therapy with streptokinuse in
mi. Ter Arkh 1996; 68:53-57.
6- kharash LM, Goldhammer EI , Abinader EI. Thrombolysis in myocardial infarction – out come optimization
methods . Klin Med (Mosk) 1998; 76: 25-29.
7- Mak KH , moliterno Dj , Granger CB , miller DP , white HD, Wilcox RG, et al . Influence of DM on Clinical out
come in the thrombolytic era of AMI. J Am coll cardiol 1997; 39:171 -179.
8- Chowdhury AR, Hossain M , Dey SR . A camparative study on the effect of streptokinase between diabetic and non
diabetic MI patients . Bangladesh J pharmacol 2008; 3:1-7.
9- Lee YY , Tee MH ,Zurkurnai Y , Than w , Sapawi M , suhairi I. Thrombolytic failure with streptokinase in acute
myocardial infarction using electrocardiogram criteria. Singa pore Med J 2008; 49:304-310.
10- White HD , Barbash GI , modan M, simes J, Diaz R, Hampton JR, et al. After correcting for worse baseline
characteristics , woman treated with thrombolytic therapy for AmI have the same mortality and morbidity as men
except for a higher incidence of hemorrhagic stroke. Circulation 1993; 88:2097-2103.
11- lew AS, Hod H , Cercek B, Shah pk , Ganz W. Mortality and morbidity rates of patients older and younger than 75
years with acute mi treated with IV Streptokinase . Am J cardiol 1987; 59:1-5.