Cardiology & Vascular Research

Abstract

Evaluation of Thrombolysis in the Management of St-Elevation Myocardial Infarction (STEMI) in Isolated Cardiology Unit

Sangaré Z, Traoré AK, Doumbia M, Sylla IS, Ndiaye MB, NGaide A, Sangaré I, Menta I, Diallo B, Dembele B, Kane AD, Diao M, Kane A, Ba SA.

Introduction: the ST-Elevation Myocardial Infarction (STEMI) is a serious cardiac emergency that requires urgent management from the setting. Thrombolysis appears to be one the rapid methods of revascularization of the coronary arteries.

Objective: The aim of the study was to assess the result of thrombolysis for STEMI in the context of isolated cardiology unit.

Patients and methods: it consisted of prospective and descriptive study from 31 July 2012 to 30 June 2014 in the Hospital of Sikasso. It included the patients admitted for STEMI treated by thrombolysis. The studied parameters were epidemiology, clinical and para clinical profiles. The fibrinolysis consisted of administrating 1.5 million international unit of streptokinase in a syringe driver during 1 hour.

Results: overall, 1237 patients were admitted in the hospital of Sikasso during the study period. 177 (14.3%) patients presented with ischemic heart syndrome; amongst them, 37 patients (2.99%) were diagnosed with STEMI. Only 24 patients benefited from fibrinolysis which represented 64.86% of patients with STEMI and 1.94% of all the hospitalized patients in the hospital of Sikasso. Male to female sex-ratio was 3. The average age was 50 years old. 50% of the patients were civil servants and more than the half (83%) were Malian. The main risk factors included smoking associated to stress (20.8%) and the association of high blood pressure and diabetes (16.7%). Regarding the clinical symptoms, 20 patients (83.33%) presented with the classic typical chest pain of acute coronary disease. The cardiovascular examination was normal in 10 patients (41.66%). Troponin test was positive in 7 patient (29.2%). On ECG, the extended anterior area was more representative (41.7%) followed by inferior area (20.8%). All the patients have benefited from echocardiogram and 19 patients (79.16%) presented a preserved left ventricle function; akinesia was the most frequent motion pathology (n=10). Four (04) patients underwent coronary angiography abroad; we noticed 1 vessel disease in 1 patient, 2 vessels disease in 2 patients and 3 vessels disease in 1 patient. The left anterior descending was the most diseased artery. The patient with 3 vessels disease underwent triple coronary artery bypass grafting. All patients were treated with streptokinase and 29.2% of patients presented complications including hemorrhagic stroke (8.3%). Mortality represented 25%. All patients treated within the first 6 hours presented clinical improvement while 37.5% of fatal cases represented those who were treated after the first six hours.

Conclusion: STEMI is a huge public health issue as it can lead to high rate of morbidity and mortality. The prognosis depends on the precocity of the thrombolysis which is clearly beneficial during the first hours.