A Study on factors influencing the outcome of thrombolysis in Acute Myocardial Infarction

Pratheesh, P P (2011) A Study on factors influencing the outcome of thrombolysis in Acute Myocardial Infarction. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION : Coronary heart disease (CHD) is a worldwide health epidemic. In the United States, for example, it is estimated that 13.7 million Americans have CHD, including more than 7.2 million individuals who already have had a myocardial infarction.1,2 From the 1960’s to the 1990’s the CAD prevalence increased two fold (from 2% to 4% )in rural India and three fold ( from 3.45 to 9.45%) in Urban India. The prevalence is even higher in South India (13% urban and 7% rural). In 1990, 25% deaths in India were attributable to cardiovascular disease compared to diarrheal disease ,12% due to respiratory infections and 5% due to tuberculosis47. In the group of persons older than 30 years of age, 213 per 100,000 individuals have CHD.1 Although agespecific events related to CHD have fallen dramatically in the last few decades, the overall prevalence has risen as populations age and patients survive the initial coronary or cardiovascular event . Worldwide 30 percent of all deaths can be attributed to cardiovascular disease of which more than half are caused by CAD. Coronary Heart disease has been defined as impairment of heart function due to inadequate blood flow to heart compared to its needs caused by obstructive changes in the coronary circulation to the heart. Thrombolytic therapy has been consistently proven to reduce the mortality and morbidity. Inspite of this it has been recognized that thrombolytic therapy has failed in significant population. There is lot of room for improvement. We need to identify the factors that are responsible for failure of thrombolysis. In this background we decided to look into our own patients who receive streptokinase for acute myocardial Infarction, in the coronary care unit of Coimbatore Medical College Hospital. AIM OF THE STUDY : 1. To find out the overall success rate of thrombolysis in coronary care unit of Coimbatore medical college hospital. 2. To find out whether the following parameters influence the outcome of thrombolysis. 1. Age, 2. Sex, 3. Pre-infarction angina, 4. Alcohol intake, 5. Smoking status, 6. Pre existing systemic hypertension, 7. Diabetes mellitus, 8. Type of Myocardial Infarction., 9. Time interval between the onset of pain and the initiation of thrombolytic therapy. MATERIALS AND METHODS : PLACE OF STUDY : This study was conducted in the coronary care unit of Coimbatore Medical College Hospital, Coimbatore. PERIOD OF STUDY : From MARCH 2009 – OCTOBER 2010. DESIGN : Observational prospective cohort study of patients receiving streptokinase for acute myocardial infarction. A total of 83 patients were included in the study. METHODOLOGY : Subject selection: 1. Inclusion criteria: a) Presence of typical chest pain suggestive of Acute myocardial infarction along with ECG evidence of acute myocardial infarction. Criteria for thrombolysis being 2mm or more ST elevation in two contiguous limb leads. b) Time window of 12 hrs from the onset of pain to the initiation of thrombolysis. 2. Exclusion criteria: a) Late thrombolysis (more than 12 hrs from the onset of pain). b) Recurrent myocardial infarction. c) Presence of bundle branch block. d) Development of pericarditis. RESULTS : A total of 83 patients were studied. Their age ranged from 34 – 76 years (mean 55.03 yrs).68 of them were males (82%) and 15 females (18%) 20 of them were hypertensives (24%). 44 people were smokers (53%) and 29 (59%) consumed alcohol. 23 patients experienced preinfarction angina (28%). 50 patients had anterior wall infarction (60%) and 33 patients (40%) had inferior infarction. CONCLUSION : 1. In this study the overall success rate of Thrombolysis was 53 %. 2. The outcome was worse in those who aged more than 60 years. But it was not statistically significant. 3. Gender was not found to influence the success rate of thrombolysis. 4. Pre infarction angina had no effect on the success rate of thrombolysis. 5. Better success rate has been seen in those consuming alcohol which was not statistically significant. 6. Smokers had a lesser success rate than non smokers but it did not reach any statistical significance. 7. Hypertensives did not show any difference with non hypertensives in the success rate. 8. Diabetics did not differ from non diabetics with respect to the success rate of thrombolysis. 9. Inferior wall myocardial infarction had a better success rate than anterior wall myocardial infarctions and was statistically significant. 10. Those who are having short window period had a better success rate after thrombolysis. Shorter the window period higher the success rate.

Item Type: Thesis (Masters)
Uncontrolled Keywords: factors influencing ; outcome ; thrombolysis ; acute myocardial infarction.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 17 Feb 2018 21:17
Last Modified: 17 Feb 2018 21:17
URI: http://repository-tnmgrmu.ac.in/id/eprint/5854

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