Original Research Paper

Factors Influencing The Outcome Of Thrombolysis In Acute Myocardial Infarction.

Abstract :

INTRODUCTION: Coronary heart disease has been defined as impairment of heart function due to inadequate blood flow to the heart compared to its needs, caused by obstructive changes in the coronary circulation to the heart1. It is the cause of 25-30% of death is most of the industrialised countries. In India also it is a major public health problem. Definitive proof for the above said concept came from angiographic studies performed during the early hours of the acute coronary event. This prompted scientists to systematically test the thrombolytic strategies to treat Acute Myocardial Infarction, opening that new era of thrombolytic therapy in Acute Myocardial Infarction. Scientists have developed many effective thrombolytic drugs like, streptokinase, recombinant tissue plasminogen activator (rt PA), Reteplase (rPA), urokinase, APSAC (Anisoylated plasminogen streptokinase activator complex) etc.AIMS AND OBJECTIVES: To find out the overall success rate of thrombolysis in the coronary care unit of Govt. General Hospital. 2. To find out whether the following parameters influence the outcome of thrombolysis.MATERIALS AND METHODS: This study includes 83 patients meeting the inclusion and exclusion criteria, done in Alluri Sitarama Raju Academy of Medical Sciences from August 2019 to October 2020.INCLUSION CRITERIA: A) Presence of typical chest pain suggestive of Acute myocardial infarction along with ECG evidence of Acute myocardial infarction who were thrombolysed. Criteria for thrombolysis being 2 mm or more ST elevation in two contiguous precordial leads or 1 mm or more ST elevation in two contiguous limb leads. ECGs were recorded using Hewlett Packard Page write 100 machine.B) Time window of 12 hrs from the onset of pain to the initiation of thrombolysis.EXCLUSION CRITERIA: 1. Late thrombolysis (more than 12 hrs from the onset of pain). 2. Recurrent myocardial infarction.3. Presence of bundle anch block. 4. Development of pericarditis.DISCUSSION: The relatively thicker wall, the increased wall thickening during systolic contraction and higher intracavitary pressure of left ventricle may all produce higher intramyocardial pressure than that is observed in the thinner walled right ventricle, which is also subjected to lower filling pressures.CONCLUSION: In this study the overall success rate of thrombolysis was 54%. Inferior wall myocardial infarctions had a better success rate than anterior wall myocardial infarctions and it was statistically significant. Smokers had a lesser success rate than non smokers, but it did not reach statistical significance.

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