Assessment of ST Segment Resolution as a Predictor of Outcome in Acute Myocardial Infarction after Thrombolysis

Abstract

category 30-40 yrs 40-59 yrs 60-74 YRS male female A < 30% 1 (11.1 %) 7 (77.8 %) 1 (11.1%) 7 (77.8%) 2 (22.2%) B 30-70% 7 (26.9%) 15 (57.7%) 4 (15.4%) 20 (76.9%) 6 (23.1%) C >70% 5 (20%) 11 (44 %) 9 (36 %) 21 (84%) 4 (16 %) TOTAL 13 33 14 48 12 PERCENTAGE 21.7 55.0 23.3 80 20 Table ; 1 Base line characteristics in ST segment resolution subgroups based on age and sex Figure 1: AGE AND SEX DISTRIBUTION OF PATIENTS Table ; 2 Based on symptoms at presentation;-Figure 2;-BASED ON SYMPTOM AT PRESENTATION categories:A, B and C. A. Category A: < 30% resolution of the sum of ST segment elevation. B. Category B: 30%-70% resolution of the sum of ST segment elevation. C. Category C: > 70% resolution of the sum of ST segment elevation. Clinical details were recorded prospectively. In hospital, major adverse eventswere defined as the occurrence of any of the following. Killip Class II-IV, Leftventricular failure, c a rd i o ge n i c s h o c k , re c u r re n t a n g i n a , s i g n i f i c a n t arrhythmias(which needs definite pharmacological, DC cardioversion and interventions likepacing) and death. Adverse events were divided according to timing< 48 hours afteradmission and> 48 hours after admission. An uncomplicated course was defined asno major adverse event during entire inpatient stay. STATISTICAL ANALYSIS: All the data were statistically analyzed using Chi-square and ANOVA. RESULTS ;-Mean age of population studied is 50.7±9.6. Male to female ratio 4:1 shows a clear male preponderance. Chest pain is most common mode of presentation seen in 95% of cases,followed by sweating and breathlessness. Smoking is most common risk in the present study, followed by hypertension and diabetes respectively. Anterior wall MI constitutes 58.3% compare to inferior wall MI 41.7%. Based on percentage of ST segment resolution after 90 minutes of thrombolysis ;-Patients divided into three categories. Patients with > 70% ST resolution (complete STR) constitute 41.7%, patients with 30-70% ST resolution(partial STR) constitutes 43.3%, patients with < 30% ST resolution (no STR) constitutes only 15%. Patients with > 70% ST resolution (complete STR) associated with less frequent adverse events during hospital stay and less inpatient mortality. Patients with 30-70% ST resolution (partial STR) associated with more frequent adverse events during hospital stay when compare to complete STR group, Patients with< 30% ST resolution (no STR group) associated with more frequent adverse events and in hospital mortality. Among adverse events, left ventricular failure is most frequent adverse events seen in 33.3% cases, followed by arrhythmias 26.7% cases recurrent angina 18.3% cases and cardiogenic shock 8.3% cases. Inpatient mortality seen in 7 cases that is 11.7% cases. Most common causes of death is cardiogenic shock 71.4% cases followed by VT / VF 28.6% cases. Based on symptoms CHEST PAIN SWEATING DYSPNEA SYNCOPE PALPITATION A <30% 9 (100%) 7 (77.8%) 6 (66%) 0 2 (22.2%) B 3o-70% 24 (92.3%) 22(84.6%) 6 (23%) 5 (19.2%) 0 C >70% 24 (96%) 23 (92%) 3 (12%) 1(4%)