Predictive Factor for Streptokinase Failure in Acute ST Segment Elevation Myocardial Infarction

Abstract

Background: In Sisaket Province, the current protocol for treating acute ST-segment elevation myocardial infarction (STEMI) involves a network system that allows consultation with cardiologists at all community hospitals. Patients diagnosed with STEMI who are eligible for Streptokinase (SK) receive SK at the community hospital. If ST segment elevation persists 60-90 minutes after SK administration, indicating ongoing artery occlusion, the patient is transferred to Sisaket Hospital for rescue percutaneous coronary intervention (Rescue PCI). However, in Sisaket Province, there are 6 districts that are more than 60 minutes away from Sisaket Hospital. Predicting the likelihood of ST segment elevation resolution or non-resolution after SK administration could benefit patients in these community hospitals.
Objective: To explore the factors predicting the failure of SK thrombolytic therapy in STEMI patients (non-resolution of ST segment elevation after SK).
Methods: Retrospective Cohort Study conducted from February 2023 to February 2024, involving 140 individuals. Data were collected by reviewing medical records of patients admitted to the hospital. The study focused on patients with STEMI diagnosed within 12 hours of symptom onset and who received SK treatment at both the community hospital and Sisaket hospital.
Results: Out of total 140 patients, 66.4% were male, and 31.4% experienced SK failure. Factors influencing SK failure included patients with Killip class 4, who had a 5.1-fold (95% CI 1.8-15.0, P-value 0.003) increase in coronary revascularization failures compared to patients with Killip class 1 when controlling for left ventricular ejection fraction (LVEF) and blood sugar levels. Patients with LVEF < 40% had a 5.9-fold (95% CI 1.6-21.9, P-value 0.008). increase in coronary revascularization failures compared to patients with LVEF ≥ 40% when controlling for Killip class and blood sugar levels Additionally, patients with random blood sugar levels ≥ 200 mg/dl had a 3.0-fold (95% CI 1.2-8.0, P-value 0.03) increase in coronary revascularization failures compared to patients with random blood sugar levels < 200 mg/dl when controlling for Killip class and LVEF.
Conclusions: Patients at high risk of non-resolution of ST segment elevation after SK administration STEMI patients with Killip class 4, LVEF < 40%, hyperglycemia
(random blood sugar≥ 200 mg/dl). In short-distance (transfer time < 60 minutes) community hospitals with a high risk of non-resolution of ST elevation after SK therapy should prefer primary PCI, while patients long-distance (transfer time > 60 minutes) community hospitals would prefer immediate referral for PCI with SK administration in the ambulance.