A Study on Factors Influencing the Success of Thrombolysis by Streptokinase in ACS - Stemi Patients in CMCH General Medicine Department

Karthik, P V (2016) A Study on Factors Influencing the Success of Thrombolysis by Streptokinase in ACS - Stemi Patients in CMCH General Medicine Department. Masters thesis, Chengalpattu Medical College, Chengalpattu.

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Abstract

INTRODUCTION: Coronary heart disease (CHD) is a health epidemic present worldwide. Results of mortality data from Global Burden of Diseases Studies: CVD especially CAD are important cause of death in India. Major causes of death around the world: cardiovascular disease, Cancer, Chronic respiratory diseases, HIV/AIDS, TB, Diabetes. Worldwide 30 % of all deaths are attributed to CVD, out of which more than half are caused by CHD. It is expected that in future the number will grow due to lifestyle changes in developing countries. Of those dying from CVD, 80% are in developing countries. STEMI is an emergency due to acute total occlusion of an epicardial coronary artery, most often due to atherosclerotic plaque rupture / erosion and subsequent thrombus formation. Compared to UA / NSTEMI, STEMI is associated with a higher in –hospital and 30 day morbidity and mortality. Left untreated, the mortality rate of STEMI can exceed 30% and the presence of mechanical complications (papillary muscle rupture, ventricular septal defect, and free wall rupture) increases the mortality rate to 90%. Keys to treatment of STEMI include rapid recognition and diagnosis, co ordinated mobilization of health care resources, and prompt reperfusion therapy. Mortality is directly related to total ischaemia time. Thrombolysis by fibrinolytic agents is still the preferred mode of treatment in India . Only 15% to 20% of patients with MI are able to undergo primary PCI, available in only a few tertiary hospitals in the city limits. Several factors contribute to success of re perfusion in a case of STEMI – age, sex, time taken from onset of pain to treatment, co morbidities like diabetes and systemic hypertension, lifestyle changes like smoking, whether AWMI OR IWMI ,etc. So, in the following study, the influence of each of these factors on the success of thrombolysis by Inj.Streptokinase in STEMI patients have been analysed and correlated with the data obtained from subjects from similar studies. AIM OF THE STUDY: 1. To study the various modifiable and non-modifiable factors influencing the success of thrombolysis in acs – stemi patients 2. Comparing the study with similar studies conducted before in famous institutions MATERIALS AND METHODS: Place of Study: The study was undertaken in IMCU, Department of General Medicine and Department of Cardiology, Chengalpattu Medical College and Hospital, Chengalpattu. Duration of Study: 1 year (June 2014 – May 2015). Population to be studied: 100. Study Group: 20 TO 75 Yrs age group complaining of chest pain and ECG showing ST elevation (AWMI / IWMI). Study Setting: IMCU, Dept of General Medicine, Chengalpattu Medical College and Hospital, Chengalpattu. Inclusion Criteria: All patients with symptoms of Myocardial Infarction and showing ECG features of ACS STEMI – ST segment elevation in leads. 1. ST segment elevation two consecutive ECG leads. • Men > 40 yrs, “ST segment elevation “at the J point > 2mm in leads V2 and V3, > 1 mm in all leads. • Men < 40 yrs, “ST segment elevation” at the J point > 2.5 mm in leads V2 and V3. • In women, “ST segment elevation” at the J point > 1.5mm in leads V2 and V3, > 1 mm in all leads. 2. New LBBB. 3. Evidence of posterior MI • Threshold for abnormal St elevation at the J point is > 0.5 mm. Exclusion Criteria: Adults not showing features of ACS – STEMI in ECG. Data Collection: The participants were explained about the study and informed consent was obtained. Then they were interviewed and analysed for inclusion/exclusion criteria. Cases which met the inclusion criteria and did not have any exclusion criteria were selected to participate in the study. 102 cases were included. Detailed history regarding patient’s age, time of presentation to hospital from the onset of symptoms, lifestyle, history of smoking, history of drug intake for hypertension or diabetes were asked. Patients with low physical activity and low commuting activity were taken as leading a sedentary lifestyle. Those who smoked > 5 cigarettes per day were considered as smokers. Symptom to needle time was taken for window period. Blood pressure was recorded and patients was auscultated fortabulating the patient as per Killip classification. Investigations Done: Blood pressure recording: Sphygmomanometer is used to record the blood pressure. BP is recorded in sitting posture in the right upper arm. Phase I Korotkoff sound was taken as systolic BP and disappearance of the sound (phase IV) was taken as diastolic BP. Electrocardiogram (ECG): ECG changes of present myocardial infarction confirmed by echocardiography by an experienced cardiologist. ECG was taken to classify patients as having AWMI or IWMI or LWMI or Triple vessel disease. Blood samples for RBS, FBS /PPBS: 1. Fasting blood glucose : done after 8 hours of fasting 2. Postprandial blood glucose : done 2 hours after taking food. Participant is diagnosed to be a diabetic if any one of the following is present: 3. FBS > 126 mg / dl. 4. PPBS > 200 mg / dl. 5. Patient already on anti – diabetic drugs. RESULTS: In the present study, where 102 patients were studied. Out of the 102 patients, 70 wre successfully thrombolysed by injection streptokinase. The various modifiable and non modifiable factors like age, gender, life style, smoking, diabetes, hypertension, window period, site of occlusion, killip classification influencing the end result of thrombolysis by injection streptokinase were analysed. The influence of window period and site of thrombus occlusion in coronary artery was found to be positive on the end result of thrombolysis with injection streptokinase, whereas all the other factors studied were not found to be significantly influencing the end result. CONCLUSION: Inferior wall myocardial infarctions had a better success rate than anterior wall myocardial infarctions and it was statistically significant. But there was no significant difference on the influence of site within the RCA or the LAD on the success of thrombolysis. Time window period significantly influenced the outcome of thrombolysis, implying that earlier the presentation, better is the success rate. Success rate was higher in those who presented in less than 3 hours. Smokers had a higher success rate than non smokers, but it did not reach statistical significance. Age-wise success rate was found to be higher in those less than 60 years of age than those of more than 60 years. But it was not statistically significant. Gender was not found to influence the success rate of thrombolysis. But in presentation > 6 hours, who underwent thrombolysis with Inj.Streptokinase, success rate was found to be higher in females than in males with statistical significance. Lifestyle was not found to influence the result of thrombolysis. Presence or absence of systemic hypertension at the time of presentation for thrombolysis had no influence on the success or failure. Diabetics do not differ from non diabetics with respect to the success rate of thrombolysis. But in those who presented in less than 3 hours with symptoms , the success rate was higher in non-diabetics than in diabetics , though it was statistically insignificant. Killip classification at the time of presentation was not found to influence the success rate of thrombolysis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: ST – Elevation Myocardial Infarction (STEMI) ; Injection Steptokinase ; thrombolysis ; smoking ; site of occlusion.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 06 Feb 2019 02:42
Last Modified: 06 Feb 2019 16:57
URI: http://repository-tnmgrmu.ac.in/id/eprint/10500

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