Treatment outcome study for acute ST-segment elevation myocardial infarction in Prapokklao Hospital.

Abstract

Objectives : 1. To demonstrate the patient profile and standard management with fibrinolytic therapy in Acute ST- Elevation Myocardial Infarction (STEMI).
2. To analyze the effectiveness of referral system and clinical pathway use in Prapokklao Hospital.

Background : STEMI remains the major leading cause of morbidity and mortality in our country.The wide spread use of fibrinolytic agent contribute to the expanding number of patients with more favorable prognosis. Little has been known about clinical outcome in fibrinolytic therapy in upcountry hospital.We therefore retrospectively collect data in STEMI patients who were admitted to cardiac care unit (CCU) of Prapokklao Hospital during the fiscal year 2005.

Methods : All consecutive STEMI patients admitted to department of medicine, Prapokklao
Hospital from October 1st, 2004 to September 30th, 2005 were retrospectively reviewed.

Results : Ninty five patients were included in the study with 40 of them received Streptokinase (SK group) while others not receiving Streptokinase (Non-SK group). We found more patients at ≥ 75 years of age in Non-SK group (p = 0.025). There was considerable number of Non-SK patients who had prior CPR. Different in number occurred between 2 subjects (p = .02) who had impaired LV function (Killip class II-IV). About half of the patients had anterior wall or LBBB; which showed no correlation with mortality. Main reasons for streptokinase (SK) not applicable were delay time to hospitalization and any contraindications for fibrinolytic therapy. Non-SK groups had longer duration from pain onset to hospitalization (mean 853.19 minutes VS 204.51 minutes respectively; p = 0.051). Mean duration from CCU to SK administration was 49.67 minutes. SK patients spent 1 day longer in CCU and in hospital. Minor bleeding episodes occurred in 7 Non-SK and 6 SK patients and only one had intracerebral hemorrhage after SK.The total expense during hospital stay was also higher in SK group (40,368.11 and 42,900.90 baht respectively). In-hospital mortality rate was 10.0 percent for SK as compare to alternative 38.2 percent (p = 0.002).

Conclusion : Early arrival within 12 hours is found to be benefit from fibrinolytic therapy in STEMI patients. It is safe when compare to outcome. Myocardium damage and mortality rate is considerable lower than conservative method. Process improvement should be encouraged to shorten time transfer to CCU to give the medication as soon as possible.