Effect of thrombolytic therapy on ventricular function of patients with acute myocardial infarction: a single institutional experience in Iraq
Background and objective: Early reperfusion has been shown to improve left ventricular function (LVF) and survival after acute myocardial infarction (AMI). We aimed to evaluate the influence of thrombolytic therapy (TT) on LVF in patients with AMI.
Methods: This study involved 100 patients who were diagnosed with acute ST-segment elevation myocardial infarction (STEMI). Patients were allocated into 2 groups; group I (n=50 patients) who received intravenous TT, and this was further subdivided equally into groups Ia and Ib; and group II (n=50), who did not receive TT. An echocardiographic-derived measurement of LVF at the end of the first and 6th weeks of the event was assessed. A left ventricular ejection fraction of ≥ 55% was considered a normal systolic function.
Results: After adjusting for age and gender, approximately 85% of group Ia patients and 50% of group Ib patients demonstrated an EF of ≥ 55% while only 16% of patients in group II had an EF of ≥55%, regardless of the infarcted area/site.
Conclusion: Thrombolytic therapy significantly improved LVF in patients with STEMI when it was administered within 12 hours of symptoms onset, than in those who did not receive this form of therapy.
WHO. The World Health Report.Changing History, World Health Organization, 2004:120-4.
Dalen JE, Gore JM, Braunwald E, Borer J, Goldberg RJ, Passamani ER, et al. Six- and twelve-month follow-up of the phase Infarction Thrombolysis in Myocardial Infarction (TIMI) trial. Am J Cardiol 1988;62:179.
Mc Govern PG, Pankow JS, ShaharE,Doliszny KM, Folsom AR, Blackburn H, et al. Recent trends in acute coronary heart disease-- mortality, morbidity, medical care, and risk factors. The Minnesota Heart Survey Investigators. N Engl J Med 1996;334:884.
Centers for Disease Control and Prevention. Mortality from coronary heart disease and acute myocardial infarction-United States, 1998. MMWR Morb Mortal Wkly Rep 2001;50:90-93.
Ishihara M, Sato H, TateishiH,Kawagoe T, Shimatani Y, Ueda K, et al. Long-term prognosis of late spontaneous reperfusion after failed thrombolysis for acute myocardial infarction. ClinCardiol 1999;22(12):787-90.
Cause of Death - UC Atlas of Global Inequality. Center for Global, International and Regional Studies (CGIRS) at the University of California Santa Cruz.Retrieved on April 7, 2012.
Heart Attack and Angina Statistics. American Heart Association, 2003.Retrieved on April 2, 2012.
Stone GW, Grines CL, Browne KF,Browne KF, Marco J, Rothbaum D, et al. Predictors of in-hospital and 6-month outcome after acute myocardial infarction in the reperfusion era: the Primary Angioplasty in Myocardial Infarction (PAMI) trail. J Am CollCardiol 1995;25:370-7.
Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group. Lancet 1994;343:311-22.
Boersma E, Maas AC, Deckers JW, Simoons ML. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet 1996;348:771-5.
Boon NA, Colledge NR, Walker BR, Hunter JA. Davidson’s Principles and Practice of Medicine, 20th Edition.London: Churchill Livingstone,2006: 595.
Andreoli TE, Carpenter CC, Griggs RC, Benjamin I. Cecil Essentials of Medicine, 7th Edition. London: Elsevier, 2007:111-114.
The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Euro Heart Journal 2006;27:2285-93.
Rosengren A, Wallentin L, GittAK,Behar S, Battler A, Hasdai D. Sex, age, and clinical presentation of acute coronary syndromes. European Heart Journal 2004; 25(8):663-70.
Al-Othman A, Al-Tawil NG. Effect of Thrombolytic Therapy on the Incidence of Early Left Ventricular Infarct Expansion in Acute Anterior Myocardial Infarction. Oman Medical Journal 2011; 26(6):431-35.
Antman EM. ACC/AHA Guidelines for the Management of Patients with ST-elevation Myocardial Infarction, 2004;105-106.
Canto JG, Zalenski RJ, OrnatoJP,Rogers WJ, Kiefe CI, Magid D, et al. Use of emergency medical services in acute myocardial infarction and subsequent quality of care: observations from the National Registry of Myocardial Infarction 2. Circulation2002;106:3018-23.
Esteghamati A, Abbasi M, NakhjavaM,Yousefizadeh A, Basa AP, AfsharH.Prevalence of diabetes and other cardiovascular risk Iranian population with acute coronary syndrome. CardiovascDiabetol 2006;5:15.
El Menyar AA, Altamimi OM, GomaaMM,Fawzy Z, Rahman MO, Bener A. The effect of high plasma levels of angiotensin-convertin enzyme (ACE) and plasminogene activator inhibiter (PAI-1) on the reperfusion after thrombolytic therapy in patients presented with myocardial infarction. Thromb Thrombolysis 2006;21(3): 235-40.
Ileri M, Tandogan I, KosarF,Yetkin E, Büyükaşik Y, Kütük E. Influence of thrombolytic therapy on the incidence of left ventricular thrombi after acute myocardial infarction: role of successful reperfusion. ClinCardiol 1999; 22(7):477-80.
Santos ES, Minuzzo L, Pereira MP, Castillo MT, Palácio MA, Ramos RF,et al. Acute Coronary Syndrome Registry at a Cardiology Emergency Center. Cardiol 2006; 87: 544-549.
Finnegan JR, Meischke H, Zapka JG, Leviton L, Meshack A, Benjamin-Garner R, et al. Preventive Medicine 2000;31: 205-13(114).
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