Evaluation of efficiency of thrombolytic therapy in patients with the acute coronary syndrome

Abstract

Evaluation of efficiency of thrombolytic therapy in patients with the acute coronary syndrome with ST segment elevation depending on the time of drug injection. Introduction: For patients with the clinical presentation of myocardial infarction with elevation of ST segment reperfusion should be performed. In the absence of contraindications and if primary percutaneous coronary intervention (PCI) cannot be used thrombolytic therapy is the method of choice. Thrombolytic therapy prevents 30 deaths per 1000 patients. The aim of the study was to analyze dynamics of ST segment reduction in patients with acute coronary syndrome with ST segment elevation, depending on the time of injection of: streptokinase, alteplase, tenekteplase. There were processed 174 medical cards of patients with acute coronary syndrome with elevation of ST segment, who underwent thrombolytic therapy with streptokinase, alteplase, tenekteplase, in the coronary care unit of Kyiv Regional Hospital over a period from 1 January 2009 to 1 January 2010. The average age of patients is 58,6±3,1. We assessed dynamics of ST segment reduction, depending on the time of thrombolytic medicine injection with the intervals of 2 hours, 2-4 hours and 4-6 hours from the beginning of clinical manifestation of acute coronary syndrome. 34 patients (20 %) underwent thrombolysis with 2 hour interval, 89 patients (51 %) - with 2-4 hour interval, 51 patients (29 %) - with 4-6 hour interval. Thrombolysis was considered to be more efficient in patients with more than 50% reduced ST segment with damaged front parts of aortic ventricle, more than 70% with damaged back parts of aortic ventricle, 90 minutes after medical injection according to ECG data in leads with maximum ST segment elevation. The results showed that thrombolysis, with 2 hour interval was effective in 30 patients (88 %), with 2-4 hour interval - in 74 patients (83 %), with 4-6 hour interval - in 28 patients (55%). Proved ST segment reduction was more frequently observed in those groups of patients who underwent thrombolysis with interval up to 4 hours comparing to the group of patients where thrombolytic therapy was carried out with 4-6 hour interval.