title: Survival of patients receiving fibrinolytic therapy for acute ST-segment elevation myocardial infarction in a developing country - patient characteristics and predictors of mortality.
abstract: There is paucity of outcomes data on patients receiving fibrinolytic therapy (FT) for acute ST-elevation myocardial infarction (STEMI) in Indo-Asians. We conducted this study to determine survival as well as correlates of mortality in this population. Hospital charts of 230 patients receiving FT for acute STEMI between January 2002 and December 2004 were reviewed. Primary outcome variable was total mortality. Cox proportional hazards regression models were constructed. At a median follow-up of 717 days, 13.5% died, majority (23) during the in-hospital period. Multivariate predictors of mortality included (adjusted hazards ratio [HR], 95% confidence interval [CI]) age (HR 1.06, 95% CI 1.01-1.13), ejection fraction (HR 0.93, 95% CI 0.89-0.97), admission white cell count (HR 1.02, 95% CI 1.01-1.04) and change in ST-segment elevation (HR 0.96, 95% CI 0.92-0.99). We conclude that patients receiving FT for acute STEMI in Pakistan are a relatively high-risk group with a 10% in-hospital mortality and high frequency of recurrent events. Comparison data with primary angioplasty as an alternative strategy are needed.
authors.affiliation: Department of Medicine, Section of Cardiology, Aga Khan University Hospital, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan. jafary@pobox.com
authors.forename: Fahim H
authors.initials: FH
authors.lastname: Jafary
authors.forename: Ahmad Zafir
authors.initials: AZ
authors.lastname: Arham
authors.forename: Fahad
authors.initials: F
authors.lastname: Waqar
authors.forename: Ali
authors.initials: A
authors.lastname: Raza
authors.forename: Hafeez
authors.initials: H
authors.lastname: Ahmed
mesh_terms: D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D010154:Pakistan / Q000453:epidemiology; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome