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Thrombolytic therapy in acute myocardial infarction in Pakistan
M A Karim1, S F Mahmood, J Akhter
1Department of Medicine, University of Nebraska Medical Center, Omaha, USA.
Insights
This study on acute myocardial infarction (AMI) in Pakistan found males were more affected, but women had more complications. Thrombolysis with streptokinase significantly reduced mortality in AMI patients.
Area of Science:
- Cardiology
- Public Health
Background:
- Acute myocardial infarction (AMI) poses a significant health challenge globally.
- Characterizing AMI features in specific populations is crucial for targeted interventions.
- The role of thrombolysis in managing AMI in Pakistan requires further investigation.
Purpose of the Study:
- To define the clinical characteristics of AMI in a Pakistani cohort.
- To evaluate the effectiveness of thrombolysis, specifically streptokinase, in reducing mortality from AMI in Pakistan.
Main Methods:
- A study of 194 consecutive patients admitted with enzyme-positive AMI.
- Data collection included patient demographics, clinical presentation, complications, and treatment received.
- Statistical analysis was performed to compare outcomes between patients who received streptokinase and those who did not.
Main Results:
- Males were three times more frequently affected by AMI than females.
- Women experienced a higher incidence of complications despite lower overall frequency.
- Anterior wall myocardial infarction was unusually common (39%), and LV failure was a predominant complication.
- Cardiogenic shock was associated with over 93% mortality.
- Streptokinase administration in 60% of patients with transmural AMI led to a statistically significant reduction in mortality (15.2% vs. 24.7%, p < 0.05).
Conclusions:
- AMI in Pakistan presents with distinct features, including a high rate of anterior wall infarction and significant complications in women.
- Thrombolysis with streptokinase demonstrates a significant benefit in reducing mortality in Pakistani patients with AMI.
- Further research and implementation of thrombolytic therapy are warranted to improve outcomes for AMI in Pakistan.
Abstract:
To characterize features of acute myocardial infarction (AMI) in a Pakistani population, and assess the role of thrombolysis in our country, we studied 194 consecutive admitted patients with enzyme positive AMI. Males were affected three times more frequently; women, although affected less, had a higher incidence of complications than men. Premature coronary artery disease (CAD) was present in 50% patients presenting with AMI. An unusually high incidence of anterior wall myocardial infarction (39%) was seen. Complications were frequent with a predominance of LV failure symptoms. Cardiogenic shock was associated with a very high mortality, in excess of 93%. Streptokinase (SK) was administered in 60% patients with suspected transmural AMI. A statistically significant reduction in mortality was seen in the group that received SK (15.2%) compared to those who did not receive SK (24.7%), (p = < 0.05).