Factor Predicting Streptokinase Failure in Acute ST segment Elevation Myocardial Infarction in Primary care Hospital.

Abstract

Background: Buri Ram province has established anAcute ST segment Elevation Myocardial Infarction(STEMI)network since 2016 to allow STEMI patients to access the treatment quickly. All primary care hospitals can start thrombolytic drug, Streptokinase (SK). If predictive factors of SK failure were known, primary care hospital can preparemedical team for emergency refer the patient to receive percutaneous coronary intervention.
Objective: To explore factors predicting Streptokinase (SK) failureinSTEMI patient at primary care hospital.
Method: This is a retrospective cohort study in STEMI patients who were diagnosed within 12 hours after the onset of symptoms and received SK thrombolytic therapy at primary care hospitals from 1st. October 2017 to 31st. October 2019. Data was analyzed with descriptive statistics andmultivariable logistic regression.
Results: 218 patients were included, 72.9% male. Average onset to needle time 172 minutes. Average door to needle time 47minutes. SKfailure 41%, and in-hospital mortality rate 10.5%. Factors predictive of SK failure were hypotension (odds ratio 5.42, p-value = 0.01 95% CI 1.36-21.5),persistent chest pain (odds ratio 9.7, p-value < 0.0195% CI 3.56-26.39), less than 50% of ST segment resolution after 45 minutesof SK administration(odds ratio 22.25, p-value < 0.0195% CI 4.74-104.39). Area under ROC curve of hypotension, persistent chest pain and ST segment resolution at 45 minutes after SKless than 50% was0.93.
Summary: Factors predictive of SK failure in STEMI patients were hypotension, persistent chest pain andST segment resolution at 45 minutes after SKless than 50%.
Keywords: ST Segment Elevation Myocardial Infarction (STEMI), Streptokinase (SK), Failure.