THROMBOLYSIS WITH INTRAVENOUS STREPTOKINASE DOSE NOT ALTER 72-HOURS MORTALITY IN ACUTE MYOCARDIAL INFARCTION

Abstract

Objective: a) To find out mortality in Acute Myocardial Infarction within 72-hours treatment in coronary care unit b) To compare mortality in Acute Myocardial Infarction treated with intravenous Heparin to that of intravenous streptokinase. Design: Observational, retrospective study Setting: Coronary care unit of Shaikh Zayed Postgraduate Medical Institute Lahore. Subject: Patient above >12 years of age, presenting with acute myocardial infarction to Coronary Care Unit from 1.9.1989 to 31.8.1990 were included and their mortality was compared with subsequent five years up to 31.8.1995. Intervention: Comparison of intravenous Heparin 5000 units stat and 1000 units hourly infusion with 1,500,000 units of streptokinase intravenous in 90 minutes in patients of Acute Myocardial Infarction along with other treatment given in both groups. Main Outcome Measures: Death as a result of Acute Myocardial Infarction during 72-hours stay at Coronary Care Unit. RESULTS: Baseline characteristics of two treatment groups were similar. Mortality rate with IV Heparin alone in 1989-90 were 2.3% (95% Cl, 0.07-4.57). With intravenous streptokinase in 1990-91 4.0% (Cl 1.28-6.7, P>0.05) in 1991-92 2.8% (CI 0.59-5.01, P>0.05) in 1992-93 2.7% (Cl 0.09-5. 42, P>0.05) 1993-94 2.8% (Cl 0.59-8.54, P>0.05) in 1994-95 4.9% (Cl 1.37-8.54, P>0.05). The mortality was slightly increased during 1991-92 but change was not significant P>0.05. There was fall in mortality from 1993-95 again statistically insignificant P>0.05. CONCLUSION: Mortality rates in Acute Myocardial Infarction remained same from 1989-90 to 1994-95. Thrombolysis with 1,500,000 units of streptokinase in acute myocardial infarction did not make any difference in mortality as compared to intravenous Heparin 5000 units stat and 1000 units/hourly within 72-hours of treatment at Coronary Care Unit.