Frequency of Total Coronary Artery Occlusion after Successful Thrombolysis in Acute ST-Elevated Myocardial Infarction (STEMI) Patients

Abstract

Objectives: To determine the frequency of total coronary artery occlusion following successful thrombolysis in patients with acute STEMI. Methodology: This study included 149 patients diagnosed with acute STEMI who achieved ≥50% resolution of ST-segment elevation within 90 minutes of thrombolytic therapy (successful thrombolysis). During their hospitalization, all patients underwent coronary angiography to assess the frequency of total coronary artery occlusion. Results: The mean age of the patients was 54.34 years (SD ± 10.8), with a gender distribution of 104 males (69.8%) and 45 females (30.2%). Despite meeting ECG criteria for successful thrombolysis, 10 patients (6.7%) had total occlusion of the culprit artery on coronary angiography. Of these 10 patients, 9 (8.7%) were male, and 1 (2.2%) was female (p = 0.15). Total occlusion of the culprit artery was significantly higher in older patients, particularly those in the 61-70 years age group, where 5 out of 25 patients (20.2%) experienced occlusion (p = 0.04). Similarly, patients with delayed thrombolysis (9-12 hours after symptom onset) exhibited a significantly higher rate of total artery occlusion, with 6 out of 13 patients (46.2%) showing occlusion (p < 0.001). A non-significant trend toward higher rates of total occlusion was observed when angiography was performed on the second day of hospitalization. Regarding the localization of STEMI on the ECG, the majority of patients had an anterior wall MI (LAD territory) with 57.05% of cases, while coronary angiography revealed that total occlusion of the culprit artery was most commonly seen in the RCA (5 cases, 11.1% of total occlusions) (p = 0.477). Conclusion: Total occlusion of the culprit artery in patients who met ECG criteria for successful thrombolysis was more prevalent in elderly patients and those with delayed presentation, highlighting the importance of timely intervention in STEMI management.