EARLY IN-HOSPITAL RE-INFARCTION AFTER THROMBOLYSIS FOR ACUTE MYOCARDIAL INFARCTION (AMI) IN AFIC/NIHD RAWALPINDI

Re-infarction After Thrombolysis

Abstract

This study was designed to determine the frequency and variables of in-hospital re-infarction after streptokinase in patients with first acute ST segment elevation myocardial infarction (AMI), hospitalized in CCU of AFIC/NIHD from Feb 2002 to July 2002. Of 200 consecutive patients of AMI who received streptokinase, 73% (n = 146) were males and 27% (n = 54) were females, mean age was 55.5 years (29-81). Frequency of in-hospital re-infarction documented in this study was 6.5% (n = 13) a median time of 2.5 days (1-6) after thrombolysis. Patients with re-infarction had higher in-hospital mortality within ten days of hospitalization (30.77% versus 7.5% without re-infarction; P = .01).  Median time to death after re-infarction was 3 days (2 - 10) with 50% of deaths occurring within 48 hours of re-infarction. Rates are comparable with previously conducted large-scale studies (GUSTO I/III and TAMI study). Advanced age, diabetes mellitus, hypertension, increasing killip class > at the time of admission, fluctuation in heart rate and hyperilipidaemias were the most important predictors /variables associated with higher in-hospital re-infarction and subsequent increased morbidity and mortality. Improved treatment, preventive strategies and early detection of re-infarction should be an important goal of AMI management. Repeat thrombolysis and early revascularization where possible in selected cases can decrease the cardiac mortality and morbidity.