Mortality outcomes and predictors of failed thrombolysis following STEMI thrombolysis in a non-PCI capable tertiary hospital: a 5-year analysis

Abstract Pharmacological reperfusion remains the primary strategy for ST-elevation myocardial infarction (STEMI) in low- and medium-income countries. Literature has reported inconsistent incidences and outcomes of failed thrombolysis (FT). This study aimed to identify the incidence, mortality outcomes and predictors of FT in STEMI pharmacological reperfusion. This single-centre retrospective cohort study analyzed data on consecutive STEMI patients who received thrombolytic therapy from 2016 to 2020 in a public tertiary hospital. Total population sampling was used in this study. Logistic regression analyses were used to assess independent predictors of the mortality outcomes and FT. We analyzed 941 patients with a mean age of 53.0 ± 12.2 years who were predominantly male (n = 846, 89.9%). The in-hospital mortality was 10.3% (n = 97). FT occurred in 86 (9.1%) patients and was one of the predictors of mortality (aOR 3.847, p < 0.001). Overall, tenecteplase use (aOR 1.749, p = 0.021), pre-existing hypertension (aOR 1.730, p = 0.024), history of stroke (aOR 4.176, p = 0.004), and heart rate ≥ 100 bpm at presentation (aOR 2.333, p < 0.001) were the general predictors of FT. The predictors of FT with streptokinase were Killip class ≥ II (aOR 3.197, p = 0.004) and heart rate ≥ 100 bpm at presentation (aOR 3.536, p = 0.001). History of stroke (aOR 6.144, p = 0.004) and heart rate ≥ 100 bpm at presentation (aOR 2.216, p = 0.015) were the predictors of FT in STEMI patients who received tenecteplase. Mortality following STEMI thrombolysis remained high in our population and was attributed to FT. Identified predictors of FT enable early risk stratification to evaluate the patients’ prognosis to manage them better..

Medienart:

E-Artikel

Erscheinungsjahr:

2023

Erschienen:

2023

Enthalten in:

Zur Gesamtaufnahme - volume:18

Enthalten in:

Internal and emergency medicine - 18(2023), 4 vom: 17. Jan., Seite 1169-1180

Sprache:

Englisch

Beteiligte Personen:

Koh, Hock Peng [VerfasserIn]
Md Redzuan, Adyani [VerfasserIn]
Mohd Saffian, Shamin [VerfasserIn]
Hassan, Hasnita [VerfasserIn]
R. Nagarajah, Jivanraj [VerfasserIn]
Ross, Noel Thomas [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

BKL:

44.80$jUnfallmedizin$jNotfallmedizin

Themen:

Asian
Emergency Department
Failed thrombolysis
STEMI
Streptokinase
Tenecteplase

Anmerkungen:

© The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI) 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:

10.1007/s11739-023-03202-1

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2144339813

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