Krishna Malakondareddy Parvathareddy1, Srinivas Ravi2, Jagadeesh Reddy Kolli3, Chethan Bharadwaj4
BACKGROUND
Acute Myocardial Infarction (AMI) can lead to death, and thrombolytic therapy
(TLT) is a common treatment protocol. However, thrombolysis is not always
successful, and there are numerous contributing factors. We wanted to compare
and contrast the coronary angiographic profile of patients with successful and
failed thrombolysis with tenecteplase.
METHODS
Cases of AMI receiving tenecteplase were categorized as successful and failed
thrombolysis groups. Fifty patients in each group were compared for various
characteristics such as age, sex, risk factors, time to thrombolysis, LV function,
number of coronary vessels involved, angiographic lesion characteristics,
thrombolysis in myocardial infarction (TIMI) flow, and to look for features that
may predispose to thrombolysis failure. To determine the association between
variables, chi-square test and logistic regression were used.
RESULTS
The mean age in the successful & failed thrombolysis group was 50.72 years and
53.48 years. Gender, diabetes, hypertension, smoking, alcohol, type of MI were
not statistically significant for failed thrombolysis. All patients with window period
< 3 hrs had successful thrombolysis and most patients with window period > 6
hrs had failed thrombolysis (87.2 %). (P < 0.001). Most patients (75.9 %) with
Type A lesions had successful thrombolysis and patients with Type B & C lesions
(88.1 %) had failed thrombolysis. (P < 0.001).
CONCLUSIONS
In patients with longer window periods, failed thrombolysis was more common
and was associated with complex coronary lesion morphology. This study
reemphasizes the value of early thrombolysis for effective reperfusion and clinical
outcome improvement.
