Preintensive care: Thrombolytic (streptokinase or tenecteplase) in ST elevated acute myocardial infarction at peripheral hospital
Related Experiment Video
Updated: Jan 27, 2026
Acute Myocardial Infarction in Rats
Published on: February 16, 2011
Himmatrao S Bawaskar1, Pramodini H Bawaskar1, Parag H Bawaskar2
1Department of Medicine, Bawaskar Hospital and Clinical Research Center, Mahad Raigad, Maharashtra, India.
Insights
Primary care thrombolysis for ST-elevation myocardial infarction (STEMI) improved reperfusion. However, tenecteplase showed significantly lower 1-year mortality compared to streptokinase in rural Indian patients.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Coronary artery disease is a leading cause of mortality in India, with acute myocardial infarction often presenting as sudden death.
- Prompt medical attention during the critical 'golden hours' is crucial for salvaging myocardium.
- Primary care physicians play a vital role in initiating early thrombolytic therapy for ST-elevation myocardial infarction (STEMI).
Purpose of the Study:
- To evaluate the 1-year mortality rates in patients receiving rapid thrombolysis for STEMI at a primary care hospital in a rural setting.
- To compare the efficacy of streptokinase versus tenecteplase in terms of reperfusion and mortality.
Main Methods:
- A retrospective study of patients admitted with typical chest pain and electrocardiogram-confirmed STEMI between 2005 and March 2016.
- Patients received either streptokinase (STK) or tenecteplase (TNP) for thrombolysis.
- Clinical data analyzed included time intervals (chest pain to hospital, hospital to needle), reperfusion rates, arrhythmias, and 1-year mortality.
Main Results:
- Of 209 STEMI patients, 162 received STK and 47 received TNP.
- In-hospital mortality was 11.11% for STK vs. 6.38% for TNP (P=0.361).
- 1-year mortality was significantly higher with STK (7.40%) compared to TNP (0%) (P=0.072).
Conclusions:
- Early thrombolysis for STEMI in primary care settings improves reperfusion outcomes.
- Tenecteplase demonstrated a trend towards significantly lower 1-year mortality compared to streptokinase.
- Further research is warranted to confirm the superior long-term efficacy of tenecteplase in rural STEMI management.
Background:
Coronary artery disease is a major cause of death in India. Sudden death preceded by chest pain is due to acute myocardial infarction. Villagers are aware and afraid of chest pain. Majority of chest pain victims attend the primary physician in golden hours. Hence, primary doctors can play important role for early thrombolysis and salvage the myocardium from irreversible injury. This study determined year mortality in a patient who received the rapid thrombolysis at primary care hospital (streptokinase or tenecteplase) at rural setting.
Setting:
Peripheral General Hospital Mahad on Mumbai-Goa highway.
Patients And Methods:
Patients with typical chest pain with electrocardiogram showed ST segment elevated myocardial infarction (STEMI) with or without risk factors admitted from 2005 to march 2016 were studied. Details clinically studied: time interval between chest pain to hospital, hospital to needle time, reperfusion and arrhythmias. Time required for regression of elevated ST segment, a response to thrombolytic (streptokinase or tenecteplase) therapy, is studied.
Results:
Total 244 patient reported with chest pain of these 35 cases brought dead with history of chest pain and convulsive moment before they died. Of these, 209 patients had acute STEMI. Of these, 162 received streptokinase (STK) and 47 received tenecteplase (TNP)]. Analysis of STK Vs TNP patients 18 (11.11%) versus 3 (6.38%) (P = 0.361) died during the treatment. Around 17 (18.49%) vs 5 (10.63%) (P = 0.941) did not show signs of reperfusion, respectively. Re infarction occurred during hospitalization 3 (2.5%) versus 3 (6.38%) (P = 0.094) cases. Around 12 (7.40%) versus 0% (P = 0.072) died at the end of 12 months of thrombolytic therapy.
Conclusion:
Thrombolysis of STEMI within golden hours improved the reperfusion. However, 1-year fatality is significance with streptokinase as compared with tenecteplase.
Related Concept Videos
00:59Hospitals-II
Nurses that work in...
01:28Hospitals-I
01:20Acute Kidney Injury V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care
03:12Freezing Point Depression and Boiling Point Elevation
The boiling point of a liquid is the temperature at which its vapor pressure is equal to ambient atmospheric pressure. Since the vapor pressure of a solution is lowered due to the presence of nonvolatile solutes, it stands to reason that the solution’s boiling point will subsequently be increased. Vapor pressure increases with temperature, and so a solution will require a higher temperature than will pure solvent to achieve any given vapor pressure, including one...
01:28Acute Coronary Syndrome IV: Interprofessional Care