Abstract

A STUDY OF THE CLINICAL AND ANGIOGRAPHIC PROFILE OF PATIENTS WITH ACUTE STEMI, THROMBOLYSED WITH STREPTOKINASE

Author(s): Jenny Madhuri Gudivada1, Padma Hemamalini Kavirayani2

BACKGROUND:  Cardiovascular diseases are leading causes of mortality and disease burden globally. In India, cardiovascular diseases have contributed to 28.1% of total deaths and 14.1% total DALYs with Ischemic Heart Disease responsible for 17.8% of total deaths and 8.7% of total DALYs. Both prevalence and mortality due to cardiovascular diseases are higher in South India. We wanted to study the clinical and angiographic profile of patients with acute STEMI, thrombolysed with STK. METHODS Patients with acute STEMI attending the ICCU, Department of Cardiology, KGH, Visakhapatnam, were included in the study. Patients within the window period of 6 hours were thrombolysed with STK if no contraindications were present. For patients presenting later than 6 hours, thrombolysis was considered up to 24 hours if there was ongoing pain or persistent ST segment elevation. Coronary angiograms were performed within one week of hospital admission in all patients. Patients of acute coronary syndromes other than STEMI, patients with acute STEMI who presented late in the window period, and in whom thrombolysis was not considered, patients who presented with Acute STEMI and had contraindications to STK were excluded. RESULTS The study group consisted of 396 subjects of which 342 (86.36%) were males and 54 (13.64%) were females. All the 5 subjects in the age group of 21-30 years were males. Out of the 63 subjects in the age group of 31-40 years, 54 (85.71%) were males and 9 (14.29%) were females. Out of the 155 subjects in the age group of 41-50 years, 141 (90.97%) were males and 14 (9.03%) were females. Out of the 104 subjects in the age group of 51-60 years, 88 (84.62%) were males and 16 (15.38%) were females. Out of the 9 subjects in the age group of 61-70 years, 54 (78.26%) were males and 15 (21.74%) were females. CONCLUSIONS STEMI is more common in males in all age groups. 70% of patients presented within 6 hours after onset of pain. Patent Infarct Related Artery is seen more commonly in males, smokers and young patients. Most of the patients with patent Infarct Related Artery had preserved LV function with EF>50%. Thrombus in the IRA is seen more commonly in old patients > 50 years and in those who presented after 6 hours of onset of pain. Most of them had LV dysfunction. Significant coronary involvement is seen in old age, females, those who presented with late window period, diabetics and hypertensives.