Study of Adverse Events of Streptokinase Therapy in Patients with Acute ST Elevation Myocardial Infarction

Background: Despite of different adverse events, streptokinase (SK) is widely used to treat patients presented with acute ST segment elevation myocardial infarction. Objective: The purpose of the present study was to observe different adverse events in patients of acute ST segment elevation myocardial infarction receiving SK infusion. Methodology: This cross-sectional type of analytic observational study was carried out in the inpatient department of Cardiology at National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from December 23rd 2019 to February 22nd 2020 for a period of two (2) months. All patients diagnosed as acute ST segment elevation myocardial infarction receiving SK were included in the present study. Adverse events were documented through completing a questionnaire by reviewing the records in the medical file as well as interviewing with the patients. Result: In this study, 43 (26.2%) patients developed different types of adverse events and 121 (73.8%) had no complications following SK infusion. The most common adverse event was hypotension i.e. 26 (60.4%) and other adverse events were bleeding 8 (4.8%) and allergic reaction 7 (4.2%). Statistically significant higher rate of adverse events occurred in diabetic, hypertensive and dyslipidemia group which was 26 (56.5%) Vs. 17 (14.4%), p = 0.000, 37 (36.6%) Vs. 06 (09.5%), p = 0.000 and 18 (54.5%) Vs. 25 (19.1%), p = 0.000 respectively. The independent factors for the development of adverse events were smoking {OR: 5.1 with 95% CI (1.7 to 15.1), p = 0.003}, diabetes {OR: 14.9 with 95% CI (5.0 to 44.8), p = 0.000}, hypertension {OR: 5.1with 95% CI (1.7 to 15.1), p = 0.003} and dyslipidemia {OR: 4.6 with 95% CI (1.5 to 13.7), p = 0.007}. Conclusion: Streptokinase infusion was associated with different adverse events. Among them the commonest one was hypotension and other less common events were minor bleeding and minor allergic reaction. The adverse events were more frequently documented in patients who were smoker, diabetic, hypertensive and dyslipidemic.

Effect of late reperfusion therapy on cardiac function and prognosis in patients with acute ST elevation myocardial infarction

Background The suitable time for treating patients with acute ST elevation myocardial infarction （STEMI） is unclear. This study was to investigate the effects of reperfusion therapy at different late times on patients with acute STEMI, in order to decide the best time for late reperfusion therapy by providing evidence-based treatment in clinical practice. Methods We enrolled 1372 patients with STEMI and receiving selective percutaneous coro- nary intervention therapy between January 1st, 2010 to December 30th, 2014. According to the time receiving PCI, these patients were divided into 3 groups： 〈3 d（n=66） ,3-6 d（n=388） and/〉7 d （n=918）. The demograph- ic, clinical and coronary angiography data, and in-hospital major adverse clinical events （MACEs） were com- pared. Results The mortality rates among 3 groups were not statistically different （0 vs. 2.6% vs. 2.0%, P= 0.375）. The incidence rate of in-hospital MACEs in 3-6 d group was lower than the other two groups, but not sta- tistic difference （25.8% vs. 16.8% vs. 21.6%, P=0.077）. By comparing the cost of hospitalization, we found that the 3-6 d group was slight lower. For patients with non-occlusive culprit vessels, although the mortality rate still had no statistic difference, the incidence rates of in-hospital MACEs were different （33.3% vs. 11.7% vs. 15.9%, P=0.003）. However, the same conclusion was not driven in patients with occlusive target vessels. Conclusions For patients with STEMI receiving late reperfusion therapy, intervention during 3-6 d might have a trend to improve prognosis.

Influence of Tirofiban maintenance duration on patients with acute myocardial infarction treated by percutaneous coronary intervention

Objective: To evaluate the efficacy and short term prognosis of Tirofiban in different treatment duration in patients with acute ST segment elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI) combined with intracoronary injection. Methods: A total of 125 patients with acute STEMI were enrolled in this study. They were randomly divided into two groups: control group (n ? 61) and Tirofiban group (n ? 64). The Tirofiban was used by intracoronary and intravenous administration in Tirofiban group which was randomly divided into three sub-groups according to the duration of Tirofiban by persistent intravenous injection for 12 hours, 24 hours or 36 hours. Thrombolysis in myocardial infarction flow and myocardial perfusion grades were recorded immediately after PCI. The adverse cardiac events and cardiac death within 180 days of PCI, and the adverse effects (hemorrhage and thrombocytopenia) were compared between the two groups and within Tirofiban sub-groups. Results: Grade 3 in myocardial perfusion was significantly better in Tirofiban group than control group (85.94% vs. 72.13%, P ? 0.03) after PCI. There was one cardiac death in control group in 180 days after PCI. The adverse cardiac event rates between two groups was significant difference (16 patients in control group and only 8 in Tirofiban group, P ? 0.047). There was no significant difference in incidence of hemorrhage complications and platelet counts between two groups. Nevertheless, hemorrhage complications in the 12-and 24-hour subgroups were less than 36-hour subgroup (P ? 0.01). Conclusions: Intravenous Tirofiban treatment reduced the adverse cardiac events and improved short term prognosis without increasing the adverse reactions of the drugs in patients undergoing PCI. The less rate of hemorrhage complication can be achieved in short-duration of Tirofiban by intravenous injection after PCI. Copyright ? 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).