Treatment time and outcome of thrombolytic therapy with streptokinase for acute ST Segment Elevation Myocardial Infarction (STEMI) in a District General Hospital of Sri Lanka: an audit

Abstract

An audit was carried out to determine the treatment time and outcome of a convenient sample of acute uncomplicated STEMI patients who received thrombolysis with streptokinase between August 2013 and October 2014 at the District General Hospital, Kalutara (DGHK), with a view to optimizing STEMI care in the region. Sixty-nine patients were analyzed for Ischemic Time, Door to Needle Time and in-hospital mortality, adverse cardiac events and complications following thrombolysis. Median Ischemic and Door to Needle Times were 3 hours and 50 minutes respectively. The proportion of patients that achieved guideline-recommended Door to Needle Time of 30 minutes and an optimal Ischaemic Time of 2 hours was low (30%). Although in-hospital mortality rate (3%) is low, 35% of patients had one or more complications following throm-bolysis before discharge. Hypotension was the commonest complication (17%), while neither intracranial bleeding nor other adverse reactions to thrombolytic agent was reported. The low proportion that received guideline-recommended treatment times and the high proportion of in-hospital complications following thrombolysis indicate the need for optimizing STEMI care.