title: Psychosocial risk factors of myocardial infarction and adverse effects of streptokinase in public sector hospitals.
abstract: OBJECTIVE
  This study investigated the psychosocial risk factors of myocardial infarction and time related adverse effects of administration of streptokinase on short-term morbidity and mortality in patients with ST-segment-elevation myocardial infarction (STEMI).
  
  
  METHODS
  One hundred patients with STEMI treated with streptokinase in the hospital setting were prospectively enrolled in the study. The primary outcome parameter was the incidence of major adverse cardiac events. During hospital stay the psychosocial and demographic risk factors were also investigated.
  
  
  RESULTS
  The overall mortality rate was similar in both groups and it was not significant. (5.7% vs 14.5%; P = 0.18). The number of recurrent chest pain was significantly higher in the group 2 compared to the group 1 (25% vs 62.5%; P = .01). The number of hypotesion was significantly higher in the group 1 as compared to the group 2 (30.7% vs 6.2%; P = .009). The demographic and psychosocial risk factors were recorded.
  
  
  CONCLUSIONS
  The early intravenous administration of streptokinase in the hospital setting leads to a reduced rate of major cardiovascular events compared to delayed administration beyond 2 hours. However, mortality rates were not significantly affected. Secondary prevention should be targeted on modifiable demographic, dietary, and psychosocial risk factors of STEMI.
authors.affiliation: Saira Afzal, MBBS, MCPS, M.PHIL, FCPS Chairperson and Head, Department of Community Medicine, King Edward Medical University, Lahore, Pakistan.
authors.forename: Saira
authors.initials: S
authors.lastname: Afzal
authors.affiliation: Muhammad Arif Khan, MBBS, M.SC APMO, Department of Community Medicine, King Edward Medical University, Lahore, Pakistan.
authors.forename: Muhammad Arif
authors.initials: MA
authors.lastname: Khan
authors.affiliation: Hafiz Muhammad Waqas khan, MBBS Department of Medicine, Mayo Hospital, Lahore, Pakistan.
authors.forename: Hafiz
authors.initials: H
authors.lastname: Muhammad
authors.affiliation: Ayesha Ashraf, MBBS Department of Medicine, Mayo Hospital, Lahore, Pakistan.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Ashraf
authors.affiliation: Maria Afzal, M.SC Department of Psychology, Government College University, Lahore, Pakistan.
authors.forename: Maria
authors.initials: M
authors.lastname: Afzal
keywords: Morbidity and Mortality; Myocardial infarction; Streptokinase administration