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ȣ - 530626 9 |
| Predictors of Failed Thrombolytic Therapy in Patients with Acute ST-Elevation Myocardial Infarction |
| 대한심장학회 Korea Acute Myocardial Infarction Registry 연구자 |
| 오미선, 정명호 안영근, 채성철, 허승호, 성인환, 김종현, 홍택종, 구본권, 채제건, 채동훈, 윤정한, 배장호, 나승운, 류제영, 김두일, 김기식, 김병옥, 오석규, 채인호, 이명용, 정경태, 조명찬, 김종진,김영조 외Korea Acute Myocardial infarction Registry Investigators |
Background: Prompt restoration of blood flow is essential to myocardial salvage and mortality reduction in patients with ST elevation myocardial infarction (STEMI). As the benefits of reperfusion decline rapidly with time, initial reperfusion strategy (thrombolytic therapy or percutaneous coronary intervention) is very important. In hospitals without PCI facilities, thrombolytic therapy may be considered. This study was designed to seek predictors of failed thrombolytic therapy with STEMI.
Methods: Total 864 patients (691 males, 58.8±12.3 year-old) treated by thrombolysis with STEMI were enrolled from Nov 2005 to Jan 2008 in Korea Acute Myocardial Infarction Registry (KAMIR). These patients were divided to two groups according to the success of thrombolytic therapy.
Results: The rate of success of thrombolysis was 73.0% (631 patients). Severe chest pain (71.9% vs. 85.9%, p=0.006), history of previous myocardial infarction (75.2% vs. 67.4%, p=0.02), Killip class III-IV (74.4% vs. 58.1%, p=0.001), non-sinus rhythm in ECG (46.9% vs. 25.6%, p=0.018), transfer from other hospital (76.6% vs. 59.7%, p<0.001), hyperglycemia in admission (187.4±105.0 vs. 168.2±65.2, p=0.002), higher serum creatinine (1.2±1.1 vs. 1.05±0.84, p=0.035) higher troponin T (10.4±12.4 vs. 6.8± 9.0, p=0.006) and higher log NT-proBNP (2.48±0.83 vs. 2.28±0.76, p=0.018) is associated with failure of thrombolytic therapy. In multivariate logistic regression analysis, non-sinus rhythm [OR 4.461, 95% confidential interval (CI) 1.171-16.99, p=0.028], severe chest pain (OR 0.196, 95% CI 0.073-0.525, p=0.001), increased troponin T (OR 0.933, 95% CI 0.897-0.970, p<0.001) and transfer from other hospital (OR 0.199, 95% CI 0.089-0.448, p<0.001) were independent predictors of failed thrombolytic therapy in patients with STEMI.
Conclusions: The patients with severe chest pain, non-sinus rhythm, increased troponin T should be considered for primary PCI instead of thrombolytic therapy. Also, reperfusion delay (transfer from other hospital) was associated with failure of thrombolytic therapy.
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