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Lee YY, Tee MH, Zurkurnai Y, Than W, Sapawi M, Suhairi I
Correspondence: Dr Lee Yeong Yeh, email@example.com
Introduction This study was primarily aimed to determine the failure rate of thrombolysis with streptokinase in acute myocardial infarction using electrocardiogram criteria and its association between various independent variables and outcome parameters.
Methods A total of 192 subjects were recruited into this retrospective observational study. Thrombolysis failure with streptokinase was defined using electrocardiogram criteria of less than 50 percent reduction in ST elevation in the worst infarct lead. Multivariate analysis was used to test association with study outcome.
Results A total of 109 patients (56.8 percent) failed thrombolysis using streptokinase. The failures were associated with five variables in multiple logistic regression analysis (backward stepwise method) including anterior location of myocardial infarct (odds-ratio [OR] 0.07, 95 percent confidence interval [CI] 0.03-0.16; p-value is less than 0.001), longer door-to-needle time (OR 1.01, 95 percent CI 1.00-1.02; p-value is 0.02), diabetes mellitus (OR 3.13, 95 percent CI 1.13-8.69; p-value is 0.03), hypertension (OR 2.06, 95 percent CI 0.92-4.60; p-value is 0.08) and high total white cell count (OR 1.12, 95 percent CI 1.01-1.24; p-value is 0.03). Thrombolysis failure with streptokinase was associated with recurrent acute coronary syndrome (crude OR 2.49, 95 percent CI 1.16-5.32; p-value is 0.02) and death after one year (crude OR 7.61, 95 percent CI 0.95-61.24; p-value is 0.04).
Conclusion This study showed that streptokinase had a failure rate of 56.8 percent. History of diabetes mellitus, history of hypertension, anterior location of myocardial infarction, longer door-to-needle time and high total white cell count were highly predictive of thrombolysis failure using streptokinase. This group of patients may benefit from other early reperfusion strategy.
Keywords: electrocardiogram criteria, myocardial infarction, reperfusion failure, streptokinase, thrombolysis failure
Singapore Med J 2008; 49(4):304-310