Effectiveness of t-PA in Patients with Acute Myocardial Infarction

Abstract

Tissue plasminogen activator (t-PA) had improve the treatment of ST elevation myocardial infarction (STEMI). The aims considered assessment the response of patients with STEMI to t-PA (Alteplase) infusion by estimate the frequency of selected parameters. This is study that included 62 patients with STEMI who had been treated with t-PA infusion as a thrombolytic therapy. They had been selected from those who had been admitted to the Coronary Care Unit at Al-Diwaniya Teaching Hospital, Diwaniya city, Iraq during the period between 1st of March 2014 to the 31st of August 2015. Specific selected parameters used to assess effectiveness of t-PA. Parameters including: resolution of ST segment elevation (reduction in the ST elevation ? 50%), relieve of chest pain, occurrence of accelerated idioventricular rhythm (AIVR) and positive response for three parameters (simultaneously), observe within 90 minutes after t-PA infusion. After t-PA infusion, 59.6% of the patients had resolution of ST segment elevation, 56.4% getting relieve of chest pain, AIVR occur in 30.6% and positive response of all parameters in 9.6%. Patients less than 60 years old age constitutes 45.1% of patients who had ST segment resolution, 30.6% of patients who had relieve of chest pain, patients with AIVR in 22.5%, and patients with positive response of all three parameters in 9.6%, (significant p.value). Smokers patients getting ST segment resolution in 41.3% of patients, relieve of chest pain in 38.7%, AIVR in 16.12% and positive response for all selected parameters in 8.06% of patients, (significant p.value). 1.61% of patients with ST segment resolution and 11.29% of patients with relieve of chest pain seen with time to perfusion more than 6 hours. This study indicated that increasing age, obesity, diabetes mellitus (DM), and delay in reaching hospital after onset of ischemic chest pain considered as predictors for poor response to t-PA infusion among patients with STEMI. BMI has no significant consideration but smokers patients had been associated with better response to t-PA.