In-Hospital Outcomes of Thrombolysed Versus Late-Presenting Non-Thrombolysed Patients With Acute ST-Segment Elevation...

Early thrombolytic therapy substantially improves outcomes in patients with acute coronary syndrome (ACS), yet its timely administration remains suboptimal in many developing regions.

To evaluate in-hospital outcomes of patients with acute ST-elevation myocardial infarction (STEMI) receiving timely thrombolysis compared with those managed with late or no thrombolysis.

This comparative observational study included 136 consecutive ACS patients, divided equally into thrombolysis (n = 68) and late/non-thrombolysis groups (n = 68). Demographic data, risk factors, clinical presentation, and in-hospital outcomes, including mortality, high WHO CVD risk at presentation, recurrent ischemia, bleeding, and resource utilization, were collected. Data were analyzed using SPSS version 26 (IBM Corp., Armonk, NY), including t-tests, chi-square or Fisher's exact tests, and multivariate logistic regression to adjust for confounding variables. Significance was set at p < 0.05.

Patients receiving thrombolysis showed significantly lower mortality (2 (2.9%) vs 12 (17.6%), p = 0.01), heart failure (10 (14.7%) vs 28 (41.2%), p < 0.001), cardiogenic shock (4 (5.9%) vs 14 (20.6%), p = 0.01), and recurrent ischemia (4 (5.9%) vs 14 (20.6%), p = 0.01). High WHO cardiovascular risk at presentation was also less frequent among thrombolyzed patients (12 (17.6%) vs 30 (44.1%), p < 0.001). Bleeding complications were rare and comparable (6 (8.8%) vs 8 (11.8%), p = 0.57), supporting the safety of timely thrombolysis. Multivariate logistic regression confirmed that thrombolysis independently reduced composite adverse outcomes (adjusted OR = 0.42; 95% CI 0.25-0.70; p = 0.001).

Timely thrombolytic therapy significantly improves in-hospital outcomes and can be safely administered in ACS patients when delivered within recommended time windows.