title: Thrombolytic failure with streptokinase in acute myocardial infarction using electrocardiogram criteria.
abstract: BACKGROUND
  This study was primarily aimed to determine the failure rate of thrombolysis with streptokinase in acute myocardial infarction using electrocardiogram criteria and its association between various independent variables and outcome parameters.
  
  
  METHODS
  A total of 192 subjects were recruited into this retrospective observational study. Thrombolysis failure with streptokinase was defined using electrocardiogram criteria of less than 50 percent reduction in ST elevation in the worst infarct lead. Multivariate analysis was used to test association with study outcome.
  
  
  RESULTS
  A total of 109 patients (56.8 percent) failed thrombolysis using streptokinase. The failures were associated with five variables in multiple logistic regression analysis (backward stepwise method) including anterior location of myocardial infarct (odds-ratio [OR] 0.07, 95 percent confidence interval [CI] 0.03-0.16; p-value is less than 0.001), longer door-to-needle time (OR 1.01, 95 percent CI 1.00-1.02; p-value is 0.02), diabetes mellitus (OR 3.13, 95 percent CI 1.13-8.69; p-value is 0.03), hypertension (OR 2.06, 95 percent CI 0.92-4.60; p-value is 0.08) and high total white cell count (OR 1.12, 95 percent CI 1.01-1.24; p-value is 0.03). Thrombolysis failure with streptokinase was associated with recurrent acute coronary syndrome (crude OR 2.49, 95 percent CI 1.16-5.32; p-value is 0.02) and death after one year (crude OR 7.61, 95 percent CI 0.95-61.24; p-value is 0.04).
  
  
  CONCLUSIONS
  This study showed that streptokinase had a failure rate of 56.8 percent. History of diabetes mellitus, history of hypertension, anterior location of myocardial infarction, longer door-to-needle time and high total white cell count were highly predictive of thrombolysis failure using streptokinase. This group of patients may benefit from other early reperfusion strategy.
authors.affiliation: Department of Medicine, Universiti Sains Malaysia, 7th Floor, Hospital Universiti Sains Malaysia, Kubang Kerian, Kota Bahru 16150, Malaysia. yylee@kck.usm.my
authors.forename: Y Y
authors.initials: YY
authors.lastname: Lee
authors.forename: M H
authors.initials: MH
authors.lastname: Tee
authors.forename: Y
authors.initials: Y
authors.lastname: Zurkurnai
authors.forename: W
authors.initials: W
authors.lastname: Than
authors.forename: M
authors.initials: M
authors.lastname: Sapawi
authors.forename: I
authors.initials: I
authors.lastname: Suhairi
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy*; D000368:Aged; D015331:Cohort Studies; D048909:Diabetes Complications; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007964:Leukocytosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013300:Streptokinase / Q000009:adverse effects*; D015912:Thrombolytic Therapy / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase