CLINICAL IMPACTS OF ST- SEGMENT NON-RESOLUTION AFTER THROMBOLYSIS FOR MYOCARDIAL INFARCTION
*Dr. Kiran Yadav and Dr. Ranjana Mandal
Objectives: We investigated the clinical consequences of non-resolution of the ST segment after thrombolytic therapy for acute ST-elevation myocardial infarction, in 100 consecutive patients admitted to a coronary care unit. Failed thrombolysis was defined as <50% ST-segment resolution at 90 minutes after the start of thrombolytic treatment. Outcomes were measured in terms of in hospital adverse events and mortality at 6 weeks. Material And Methods: A total of 100 patients with first episode of ST elevation myocardial infarction without any conventional contraindication for thrombolysis were taken for the study. % of ST segment resolution after 90 min of thrombolysis was calculated and correlation with Ttn, ejection fration, arrhythmia, prognosis in the patients with acute Myocardial Infarction. Results: Out of 100 patients who were thrombolysed, 30% had failed thrombolysis. Patient who presented within 6 hours of chest pain had 7.7% failed thrombolysis which was significantly lower than patients who presented >6 hrs of chest pain with 44.5% failure rate, p value 0.0002. patients with positive troponin T on admission were having high thrombolysis failure 40.8% as compared to 17.4% failure rate in patients with negative troponin T on admission p value 0.0203. Conclusion: Long symptom to needle time is an important predictor of failed thrombolysis in acute myocardial infarction patients. Persistence of chest pain beyond 2 hours and non-resolution of reciprocal ST depression can serve as additional markers of failed thrombolysis. As failed thrombolysis can be associated with poor prognosis its recognition and appropriate further management is needed.
Keywords: Acute Coronary Syndrome (CAD), ST segment elevation, ST segment resolution, Thrombolysis.
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