Thrombolysis for acute myocardial infarction in Moroccan patients: Data from FES-AMI registry

Abstract

Acute myocardial infarction (AMI) is the most serious form of acute coronary syndrome. It is essentially due to occlusive coronary thrombosis complicating rupture of atherosclerosis plaque. The aim of the management of this extreme emergency is to restore the coronary flow as soon as possible either by thrombolysis or by primary angioplasty depending on local conditions. To assess clinical, angiographic, therapeutic and prognostic features of Moroccan patients thrombolysed by tenecteplase in AMI. FES-AMI is a monocentric prospective registry that included all patients hospitalized for management of AMI within 5 days of onset of symptoms. We analyzed from this registry all patients who had undergone thrombolysis with tenecteplase between June 2006 and August 2018. We enrolled 900 patients. 79% of patients were males and mean age was 60 years old. 57% of patients were smokers, 35% were diabetics and 26% were hypertensives. A total of 71% of patients had more than 2 risk factors. In 80% of cases, patients are thrombolysed beyond the 3rd hour. Our patients received thrombolytic therapy within an average of 5 hours and 14 min after the onset of chest pain. All patients received Aspirin, Clopidogrel and Heparin. TIMI flow grade 2 or 3 has been found in 95% of successful thrombolysis. 60% of patients had multi-vessel disease. The heart failure complicated the myocardial infarction in 35% of cases. 8% of patients presented an atrial fibrillation, 5% a ventricular tachycardia, 3% a ventricular fibrillation and 4% a third-degree atrioventricular block. The rate of intracranial hemorrhage was 1%. The in-hospital mortality was 7.1%. Fibrinolysis remains an important option for reperfusion in acute myocardial infarction in Morocco. Higher rates of patency were observed in successful thrombolysis in our registry. Intracranial hemorrhage was the most serious complication of fibrinolytic therapy and its frequency did not exceed 1%.