Thrombolysis For Acute Myocardial Infarction Research Articles

A Study on QT Dispersion before and after Thrombolysis in Acute Myocardial Infarction and its Prognostic Implications: A before and after Comparison Study.

Introduction: Acute myocardial infarction (AMI) stands as one of the most catastrophic occurrences in the progression of coronary artery disease. Measuring QT dispersion (QTd) is a fairly straightforward and noninvasive technique for predicting mortality in patients at high risk following a myocardial infarction (MI). Objective: To measure the QT, corrected QT interval (QTc), QTd, and corrected QT dispersion (QTcd) intervals before and after thrombolysis in patients with AMI and to determine prognostic implications of QTd in AMI. Materials and methods: This was a before and after comparison study conducted in the intensive care unit (ICU) of a tertiary care center in Central India. It was carried out in patients with AMI [ST-elevation myocardial infarction (STEMI)] who underwent thrombolysis in ICU. A total of 160 participants were enrolled over the time period of 24 months using the convenience sampling technique. Results: The most prevalent (68 patients) risk factor among MI patients was hypertension (HTN). QT parameters such as QT, QTd, and QTcd showed significant statistical variation of p-value < 0.0001 when compared at admission and after thrombolysis. No significant difference (p > 0.05) in QT parameters at admission (QTd, QTc, and QTcd) between anterior and inferior wall MI, except for QT interval (p = 0.0010). Among the 33 patients who experienced arrhythmia, ventricular tachycardia was the most prevalent arrhythmia in 22 patients (13.75%). There was a significant statistical correlation between the arrhythmic event and the outcome of the patient (p < 0.0001). Patients who died had higher QT parameter values at admission, and these remained on the higher side even after thrombolysis, whereas those who got discharged had lower QT parameter values at admission, and their values decreased after thrombolysis. Conclusion: Successful thrombolysis significantly decreases the QTd and thereby the arrhythmogenic potential, and thus can also be used as a reliable predictor of arrhythmia in patients of MI. How to cite this article: M A, Khandait H, Guralwar C, et al. A Study on QT Dispersion before and after Thrombolysis in Acute Myocardial Infarction and its Prognostic Implications: A before and after Comparison Study. J Assoc Physicians India 2023;71(10):14-18.

Thrombolysis for acute myocardial infarction in early post-renal transplant period: A case report

Cardiovascular disease is a major contributor to morbidity and has become the leading cause of death among renal transplant patients. This paper presents a case of acute myocardial infarction occurring three weeks after a renal transplant. A 45-year-old male recipient experienced acute chest pain, hypotension, and atrial fibrillation, leading to a diagnosis of inferior-posterior wall myocardial infarction. Thrombolysis with Tenectaplase was administered, resulting in the development of a perinephric hematoma six hours later. The patient underwent transfusions and pigtail drainage of the hematoma. Following hematoma resolution, the pigtail catheter was removed, and the patient was started on dual anti-platelets. Upon discharge, the patient exhibited stable renal function. In conclusion, thrombolysis in the early post-transplant period poses significant risks. This case highlights the use of thrombolytic therapy during this period and the successful management of associated complications.

Clinical value of GRACE score combined with DFR in predicting short-term prognosis of patients undergoing early PCI after thrombolysis for acute myocardial infarction.

The aim of the study was to investigate the clinical value of the Global Registry of Arterial Events in Acute Coronary Syndromes (GRACE) score combined with the D-dimer/fibrinogen ratio (DFR) in predicting the short-term prognosis of patients undergoing percutaneous coronary intervention (PCI) early after thrombolysis for acute myocardial infarction (AMI). A total of 102 patients who underwent PCI early after thrombolysis for AMI during April 2020 to January 2022 in our hospital were picked as study subjects. These subjects were assigned as the good prognosis group (without adverse cardiovascular events) and poor prognosis group (with adverse cardiovascular events) according to whether adverse cardiovascular events occurred during hospitalization and follow-up. Changes in GRACE scores and DFR levels in patients with different prognoses were analyzed. The GRACE score and DFR level of patients with different prognosis were analyzed. The clinic pathological characteristics were collected, and the risk factors for poor prognosis of AMI patients were analyzed by logistic risk regression; ROC curve was used to analyze the prognostic value of GRACE score combined with DFR in early PCI patients after AMI thrombolysis. Compared with the good prognosis group, the GRACE score and DFR level in the poor prognosis group were much higher (p<0.001). Significant differences existed in blood pressure, ejection fraction, number of diseased branches, and Killip grading between the patients with good prognosis and those with poor prognosis (p<0.05). There existed no significant difference in clinical medication between the patients with good prognosis and those with poor prognosis (p>0.05). Logistic multivariate analysis indicated that GRACE score, DFR, ejection fraction, number of lesion branches, and Killip grade were all risk factors influencing the prognosis of patients undergoing early PCI after thrombolysis in AMI (p<0.05). The ROC curve was established and the area under the curve (AUC) of GRACE score, DFR, and combined detection were 0.815, 0.783, and 0.894, respectively, and the sensitivity and specificity were 80.24%, 60.42%, 83.71%, 66.78%, 91.42% and 77.83%, respectively. The AUC, sensitivity, and specificity of combined detection were higher than those of the two alone and had a higher predictive value for the short-term prognosis of patients. The GRACE score combined with DFR was of great value in diagnosing the short-term prognosis of patients undergoing PCI early after thrombolysis for AMI. Furthermore, the GRACE score, DFR, ejection fraction, number of lesion branches, and Killip classification were all important factors influencing the short-term prognosis of patients, which were of great significance in determining the prognosis of patients.

Reduction of door-to-needle time in the management of patients with acute myocardial infarction admitted to the coronary care unit in District General Hospital Matara Sri Lanka

<strong>Introduction:</strong> Acute myocardial infarction (MI) is the leading cause of death in Sri Lanka. The American College of Chest Physicians (ACCP) guidelines recommend that for patients with acute MI who are candidates for fibrinolytic therapy, the therapy should be administered within 30 min of arrival at the hospital or first contact with the healthcare system (grade 1A). <strong>Objective:</strong> To reduce door-to-needle time to 30 minutes in the management of patients with ST elevated myocardial infarction (STEMI) admitted to the coronary care unit in District General Hospital (DGH) Matara. <strong>Methodology:</strong> A clinical audit was done by analyzing the prevailing process of thrombolysis for acute MI. Based on the identified gaps an integrated care pathway (ICP) was introduced as an intervention. This included the removal of irrelevant steps, avoiding unnecessary delays, and assigning a responsible person to each step in the process. A comparison was done between pre and post-interventional groups. <strong>Results:</strong> Door-to-needle time was significantly shorter after the introduction of ICP (intervention). <strong>Conclusion:</strong> ICP is a good tool for quality assurance. It was helpful in reducing the door-to-needle time in the management of patients with STEMI admitted to the cardiac care unit in DGH Matara, once it was used as the intervention in clinical audit.

Observation and Safety Analysis of Recombinant Human Urokinase Primary Thrombolysis in Acute Myocardial Infarction

Observation and Safety Analysis of Recombinant Human Urokinase Primary Thrombolysis in Acute Myocardial Infarction

Clinical Observation of Delayed Percutaneous Coronary Intervention after Intravenous Thrombolysis in Acute Myocardial Infarction

Clinical Observation of Delayed Percutaneous Coronary Intervention after Intravenous Thrombolysis in Acute Myocardial Infarction

Thrombolysis on first contact saves minutes and myocardium

ABSTRACT OBJECTIVE: To compare the door to needle time (DNT), for thrombolysis in acute myocardial infarction, at the new chest pain clinic at emergency room, with the old CCU at the cardiology Department LRH Peshawar. METHODOLOGY: This was a retrospective study conducted at Lady reading Hospital, Peshawar. Two data sets were acquired from hospital records. One for CCU at the cardiology department covered the span from 1st July till 30th sept: 2010. The other for the chest pain clinic emergency department covered the span from 1st April to 15th May, 2017. All the patients having ST elevated acute myocardial infarction eligible for thrombolytic therapy were included in the study. Door to needle time was calculated in both the groups. Comparison of DNT between both groups was made by using student t-test with p-≤0.05 taken as significant. Comparison between other base line qualitative characteristics was made by using chi square test with p-≤0.05 taken as significant. RESULTS: Total of 140 patients were enrolled in CCU group with mean age of 57.96±13.5 years. Out of these 60% were male. While 209 patients were enrolled in ED group with mean age of 58.85±6.9 years. Of these 65.1% were males. Mean DNT in CCU group was 72.42±50.85 minutes while in ED was 31.96±16.6 minutes with p-value 0.0001 with a reduction of 41.30 minutes in the DNT. DNT of &lt;30 minutes and between 30-60 minutes was achieved in 7.1% and 62.8% in CCU group while in rest it was more than 60 minutes. In ED group the DNT achieved was &lt;30 minutes in70.8% and 30-60 minutes in 29.2% of patients while none fell in category of &gt;60 minutes. CONCLUSION: The door to needle time for thrombolytic administration for acute myocardial infarction was significantly less at the chest pain clinic at emergency room than at the CCU at cardiology department.

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

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%.

Outcome of Thrombolysis in Acute Myocardial Infarction in a Tertiary Care Hospital

Introduction: The main purpose of thrombolysis in acute myocardial infarction is early and complete reperfusion. Incomplete or delayed thrombolysis is associated with an increased risk of death and left ventricular dysfunction. The time to reperfusion and complete reperfusion remain the key determinants for appropriate outcome of cardiovascular events.&#x0D; Objective: To find out the effect of thrombolytic therapy and its outcome in relation with timing of thrombolysis and associated risk factors in ST elevated myocardial infarction (STEMI) patients.&#x0D; Materials and Methods: This cross-sectional interventional study was carried out in combined military hospital, Dhaka from July 2017 to May 2018. Total 85 patients of acute STEMI having specified criteria were selected and treated with Streptokinase at a dose of 1.5 million units diluted in 100 mL normal saline. Twelve-lead ECG was recorded immediately before the start of thrombolytic therapy and 180 min afterwards.&#x0D; Results: Among 85 STEMI patients 65 were male and the age range was 40-80 years. Sixty nine patients (81.2%) underwent thrombolysis within 12 hours of onset of chest pain among them complete resolution of ST segment occurs in 45(65.2%) patients while 16 patients (18.8%) received thrombolysis after 12 hours among them complete resolution occurs only in 7(43.8%) patients. Fully reperfused patients have no complications. Patients having diabetes mellitus, presented with atypical chest pain and received thrombolytic therapy after 12 hours had various types of complication.&#x0D; Conclusion: STEMI patients received thrombolysis therapy within 12 hours of onset of chest pain responded well to thrombolytic therapy.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 42-44

TCTAP A-122 Gender Differences in Outcomes After Primary Angioplasty Versus Thrombolysis in Acute Myocardial Infarction

Gender differences in the diagnosis and treatment of ST-segment elevation acute coronary syndrome have important and direct implications for health. Many disparities are observed in the literature and discrepancies can be found from an observation to another. We tried to make our contribution by

Рідкісний випадок спонтанного тромболізису у пацієнтки з гострим інфарктом міокарда з елевацією сеґмента ST

In the pathogenesis of acute myocardial infarction an important role belongs to coronary sclerosis and coronary artery thrombosis. Endothelium plays an important role in a regulation of vascular tone, local inflammation, hemostasis, neovascularisation. An impairment of endothelial barrier function occurs after direct damage of endothelial cells as a result of an atherosclerotic plaque destabilization, injury, chronic inflammation or exposure to hazardous substances. Breakage of the endothelial surface causes an exposure of subendothelial collagen and triggers expression of adhesive proteins (e.g. tissue factor and von Willebrand factor) and decreases synthesis of prostacyclin and nitric oxide. In case of its damage and activation, thrombocytes adhere and aggregate to each other which leads to thrombosis and can cause an acute myocardial infarction.&nbsp; Aim.&nbsp;Our aim was to evaluate a cellular mechanisms of thrombosis as well as conditions that leads to spontaneous thrombolysis in acute myocardial infarction for treatment optimisation of acute coronary syndrome. &nbsp; Material and Methods.&nbsp;The case of acute myocardial infarction with ST segment elevation in 79 years old patient is presented that showed spontaneous coronary blood flow recovery.&nbsp; Results and Discussion.&nbsp;In described case in a patient with acute myocardial infarction a rapid regression of ECG changes were documented after medical treatment at home was provided. Those changes were most likely a results of spontaneous thrombolysis with subsequent recovery of coronary blood flow in infarct-related artery due to rarely occurring activation of fibrinolytic system. The fibrinolysis system was triggered by the release of plasminogen activator and affected newly formed thrombus. However unstable atherosclerotic plaque was thrombogenic enough and leaded to recurrence of myocardial infarction. Thus the patient received coronary artery stenting. Clinical and morphological data has shown that in those patients a major role in development of acute coronary syndrome plays not a coronary artery spasm but a coronary thrombosis with subsequent spontaneous thrombolysis and restoration of coronary blood flow which happened upon timely application of antiaggregants, anticoagulants and antianginals drugs. Coronary artery spasm typically occurs more distal from the obstruction place as a result of exposure to vasoconstrictors released after thrombocyte degranulation. Spontaneous thrombolysis by acute myocardial infarction is untypical, hence myocardial infarction with pathological Q wave develops.&nbsp; Conclusions.&nbsp;Patients with acute coronary syndrome, which exhibit spontaneous thrombolysis require angiography and stenting of coronary arteries as soon as possible to prevent recurrence of coronary thrombosis and development of acute myocardial infarction.

Clinical Markers of Reperfusion in Patients with Acute Myocardial Infarction and Its Prognostic Significance

Abstract Introduction: Coronary artery disease (CAD) is a major cause of mortality worldwide. Thrombolysis in the treatment of acute myocardial infarction (AMI) is a landmark event in the management as it has changed the outcomes. Clinical signs after thrombolysis in AMI may have a better correlation with functional reperfusion than the isolated image of angiographic patency. Aims and objectives: To study successful clinical reperfusion (SCR) noninvasively using clinical markers of reperfusion. To evaluate the prognostic value of clinical markers of reperfusion in predicting early (30 days) prognosis after thrombolysis in AMI. To observe the effect of age, location of MI, presence of previous infarction, Killip's class at admission, and presence of clinical reperfusion assessed noninvasively on early (30 days) prognosis after AMI. Materials and methods: All the patients were thrombolyzed (using streptokinase). Successful clinical reperfusion was defined by the presence of at least two of the following criteria at 2 hours of starting treatment: (1) Significant relief of pain (50% or more), (2) 50% or more reduction in sum of ST segment elevation, (3) abrupt initial rise of creatine kinase MB (CK-MB) level, more than two-fold over upper normal or baseline values. Results: Duration of symptoms (min) mean ± SD was nearly the same in two groups (94.80 ± 13.68 vs 96.19 ± 17) but early thrombolysis resulted in better outcome (0.01 S, p &lt; 0.05). killips class at admission (KAD) &gt; OR = 2, n (%) led to worsened fate of thrombolysis. Death n (%) occurred in 7 (8.75%) patients with 1 (1.25%) from SCR (+) group and 6 (7.5%) from SCR (–) group (0.01 S, p &lt; 0.05). Conclusion: It is concluded that Killip's class at admission of more than or equal to two and absence of SCR are the predictors of mortality after thrombolysis. Absence of SCR defines a group of patients with poorer prognosis after thrombolysis and in such patients alternative strategies of reperfusion should be considered.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

What we have learned from a decade of ED crowding research.

What we have learned from a decade of ED crowding research.

Thrombolysis-related intracerebral hemorrhage and cerebral amyloid angiopathy: accumulating evidence.

Intracerebral hemorrhage (ICH) is the most feared risk of systemic thrombolysis for ST-elevated myocardial infarction, pulmonary embolism, or acute ischemic stroke. Clinical, radiological, and pathological evidence suggests that cerebral small vessel disease and, in particular, cerebral amyloid angiopathy (CAA) may contribute to or in some cases directly underpin thrombolysis-related intracerebral hemorrhage (TICH) (1). Further developments, particularly in neuroimaging, have strengthened this hypothesis, hinting at the prospect of identifying biomarkers to measure TICH risk for individual patient groups. Emerging biomarkers for CAA such as lobar cerebral microbleeds (2) may become increasingly useful for outcome endpoints in clinical trials and patient risk stratification for TICH (3). Thrombolysis-related intracerebral hemorrhage is a complex pathophysiological process. For ischemic stroke patients, a key issue is the location of TICH, i.e., hemorrhage into the area of ischemia vs. hemorrhage in a remote non-ischemic site (occurring in about 20% of patients with symptomatic TICH). Classification of TICH has traditionally focused on clinical and radiological features (4), with less emphasis on whether different mechanisms might be implicated in TICH in remote from or within the acute infarcted region (5) or whether pathological assessment has occurred. Coregistered Pittsburgh compound B positron emission tomography (PiB-PET) imaging has revealed that spontaneous hemorrhage hotspots preferentially occur at locations with increased amyloid β-protein burden (6). In patients treated with recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke, cerebral amyloid β-protein (as detected with PiB-PET) retention was higher in patients with parenchymal hemorrhage compared to patients without (7). Although PiB-PET has somewhat poor spatial resolution and cannot reliably resolve parenchymal and cerebrovascular amyloid β-protein, the finding is probably one of the strongest pieces of radiological evidence implicating CAA in TICH. Matrix metalloproteinase 9, a zinc-dependent endopeptidase and a marker of hemorrhagic transformation after ischemic stroke, is released from neutrophil granules by rt-PA in humans (8). Amyloid β-protein can also release and activate MMP-9 from mouse endothelial cells (9), suggesting that convergent risk factors may lead to hemorrhage. Cerebral microbleeds identified on MRI in a lobar distribution are considered a characteristic hemorrhagic marker of a vasculopathy related to CAA (2). It has slowly emerged that multiple microbleeds might increase the risk of symptomatic ICH following thrombolysis treatment, a relationship which increases with increasing numbers of microbleeds (10, 11). In more recent studies with larger groups of ischemic stroke patients receiving intravenous thrombolysis in both European and Chinese populations, multiple cerebral microbleeds were more clearly associated with symptomatic and parenchymal hemorrhage, respectively (12, 13). Future study may provide insights into potential mechanisms, and meta-analyses may highlight the relative importance of lobar and non-lobar cerebral microbleeds in stratifying the intracerebral hemorrhagic risk from thrombolysis. In a review in 2004 (1), we identified 10 patients with pathological investigation of TICH, 7 of whom had evidence of CAA. All of these patients had been treated for acute myocardial infarction and nine of the patients had multiple hemorrhages in a lobar distribution. With an increasing emphasis on primary percutaneous intervention for ST-elevated myocardial infarction, it may not be surprising that no further TICH cases following thrombolysis for acute myocardial infarction have been reported. However, although thrombolysis rates have increased for acute ischemic stroke patients, in an updated systematic literature search, only two further autopsy TICH cases (multiple and both hemispheres) have been reported in the stroke literature, both of whom had CAA (14). The relative lack of human pathological studies compared to neuroimaging studies hampers further developments in this area. A pathological register attached to a clinical register would enhance our understanding of TICH, particularly in the older population with acute ischemic stroke. The known predictors of clinically significant TICH currently include age, clinical stroke severity, high blood pressure, hyperglycemia, early CT ischemic changes, large baseline diffusion lesion volume, leukoaraiosis, and cerebral microbleeds on MRI; the evidence for a role of CAA in TICH continues to accumulate.

Acute stroke with concomitant acute myocardial infarction: will you thrombolyse?

Acute stroke with concomitant acute myocardial infarction: will you thrombolyse?

Catastrophic hemorrhage of adrenal pheochromocytoma following thrombolysis for acute myocardial infarction: case report and literature review

We describe here the case of a 62-year-old man with acute abdominal syndrome and severe hemorrhagic shock following successful thrombolysis for acute cardiac infarction. Emergency surgical exploration revealed extensive intraperitoneal and retroperitoneal hemorrhage resulting from the rupture of a large adrenal tumor. The diagnosis of pheochromocytoma was confirmed by histological findings. The patient died a few hours after surgery from multiorgan failure despite resuscitation attempts. This report discusses the diagnosis difficulties, treatment approach, and relevant literature.

Young coronary artery disease in patients undergoing percutaneous coronary intervention

BACKGROUND AND OBJECTIVESUnderstanding the nature and pattern of young coronary artery disease (CAD) is important due to the tremendous impact on these patients’ socio-economic and physical aspect. Data on young CAD in the southeast Asian region is rather patchy and limited. Hence we utilized our National Cardiovascular Disease Database (NCVD)—Percutaneous Coronary Intervention (PCI) Registry to analyze young patients who underwent PCI in the year 2007 to 2009.DESIGN AND SETTINGSThis is a retrospective study of all patients who had undergone coronary angioplasty from 2007 to 2009 in 11 hospitals across Malaysia.METHODSData were obtained from the NCVD—PCI Registry, 2007 to 2009. Patients were categorized into 2 groups—young and old, where young was defined as less than 45 years for men and less than 55 years for women and old was defined as more than or equals to 45 years for men and more than or equals to 55 years for women. Patients’ baseline characteristics, risk factor profile, extent of coronary disease and outcome on discharge, and 30-day and 1-year follow-up were compared between the 2 groups.RESULTSWe analyzed 10 268 patients, and the prevalence of young CAD was 16% (1595 patients). There was a significantly low prevalence of Chinese patients compared to other major ethnic groups. Active smoking (30.2% vs 17.7%) and obesity (20.9% vs 17.3%) were the 2 risk factors more associated with young CAD. There is a preponderance toward single vessel disease in the young CAD group, and they had a favorable clinical outcome in terms of all-cause mortality at discharge (RR 0.49 [CI 0.26–0.94]) and 1-year follow-up (RR 0.47 [CI 0.19–1.15]).CONCLUSIONWe observed distinctive features of young CAD that would serve as a framework in the primary and secondary prevention of the early onset CAD.

Early application of an intra-aortic balloon pump in patients with ST-segment elevation acute myocardial infarction scheduled for elective percutaneous coronary intervention

This study evaluated the effect of early application of intra-aortic balloon pump (IABP) counterpulsation in patients with ST-segment elevation acute myocardial infarction (STEMI), scheduled for elective percutaneous coronary intervention (PCI). Patients who had experienced STEMI for 12-72 h received (IABP group) or did not receive (control group) IABP counterpulsation for 3-5 days before PCI. One hundred patients were included. Frequencies of infarct-related artery thrombolysis in acute myocardial infarction (TIMI) flow rate classes 0, I and II in the IABP group (11.5, 1.9 and 7.7%, respectively) were significantly lower than in the control group (29.1, 14.6 and 22.9%, respectively) before PCI. After PCI, the frequency of TIMI class III flow rate in the IABP group (96.2%) was significantly higher than that in the control group (81.3%). Four weeks after PCI, the left ventricular ejection fraction (LVEF) was significantly higher, and the incidence of major cardiac events was significantly lower, in the IABP group compared with the control group. Early use of IABP counterpulsation in STEMI patients scheduled for PCI was effective, with a favourable safety profile. IABP counterpulsation reduced the incidence of major adverse cardiac events and improved LVEF. However, IABP devices must be used at an early stage, to obtain optimal results.

PREDICTORS OF FAILED THROMBOLYSIS IN ACUTE MYOCARDIAL INFARCTION

objectives: Acute myocardial infarction(AMI) is becoming increasingly important problem in developing countries, and thrombolysis is the main modality of treatment here. About 25-50% of patients fail to achieve successful reperfusion and these patients have poor prognosis. Since alternative modes of reperfusion are available, it is important to identify them. This study was aimed at defining the extent of failed thrombolysis and identifying its demographic and clinical predictorsMethods: 50 cases of thrombolysed AMI patients were studied. Failed thrombolysis considered if there is 0.05), percentage of females was 25% v/s 16.7%(P>0.05), mean time for resolution of chest pain was 3.55±1.1 hrs v/s. 1.98±0.93 hrs (P 0.05), inferior wall MI was 30% v/s 46% (P>0.05) in failed and successful group respectivly. Interpretation and conclusion.Late presentation is an important risk factor for failed thrombolysis in AMI. Persistence of chest pain and non-resolution of reciprocal ST depression are significantly associated with failed thrombolysis.