Characteristics and outcomes of patients admitted with an ST Elevation Myocardial Infarction, who underwent thrombolysis with Tenecteplase at the Teaching Hospital Batticaloa.

Abstract

Ischemic heart disease is a major cause of death worldwide, accounting for 16% of deaths according to the World Health Organization. It is also the leading cause of hospital deaths in Sri Lanka. Risk factors for Ischemic Heart Disease (IHD) include both non-modifiable factors such as advanced age and male gender and modifiable factors like diabetes, hypertension, and smoking. Major adverse cardiovascular events (MACE) is acomposite endpoint for measuring the long-term impact of IHD. Tenecteplase is used for acute management of ST Elevation Myocardial Infarction (STEMI), for patients in non-PCI (Percutaneous Coronary Intervention) capable hospitals. The Teaching Hospital Batticaloa is such a setting where Tenecteplase is used in the acute management.The objectives are to study selected characteristics and outcomes of patients admitted with an ST Elevation Myocardial Infarction, who underwent thrombolysis with Tenecteplase at, Teaching Hospital Batticaloa and to determine the association of selected characteristics to the outcomes of these patients. The study was a retrospective analysis of patients with ST Elevation Myocardial Infarction who underwent thrombolysis with Tenecteplase at the Teaching Hospital Batticaloa. The study population included patients admitted with ST Elevation Myocardial Infarction from 1st of August 2021 to 1st of August 2022 and managed at the Coronary Care Unit (CCU) of the hospital, while excluding patients managed at medical wards, transferred from the ETU for rescue PCI, who died at the ETU prior to transfer to the CCU and with incomplete records. The study was conducted from March 2022 to January 2023. The sample size was complete enumeration. Data was collected from the record books of patients maintained at the CCU and divided into 6 segments: Demography, Risk factors, Types of STEMI, Thrombolytic therapy outcome, Left ventricular impairment, and Major Adverse Cardiac Events and other non-fatal outcomes. The data was manually extracted and entered into a Google Form and later transferred to an excel data sheet for analysis using the Statistical Package for Social Studies. A total of 165 records of patients admitted to the Coronary Care Unit of the Teaching Hospital Batticaloa were considered for the study. The mean age of patients was 56.88 years (SD = 11.74) with a majority of them (48.5%, n = 80) being between 41-60 years of age. 72.7% (n = 120) of the patients were male, with a mean age of 56.23 years, while 27.3% (n = 45) were female, with a mean age of 58.60 years. The majority of the patients were Tamils (65.5%, n = 108), followed by Muslims (31.5%, n = 52) and Sinhalese (3%, n = 5). 43.6% (n = 72) of the patients were smokers, 29.1% (n = 48) consumed alcohol, 46.7% (n = 77) had diabetes, 49.1% (n = 81) had hypertension, 12.1% (n = 20) had ischemic heart diseases, 9.7% (n = 16) had dyslipidemia, 3.6% (n = 6) were obese and 8.5% (n = 14) had poor dietary habits. 14.5% (n = 24) of the patients had a family history of ST elevated myocardial infarction. The majority of presentations were inferior STEMI (43.6%, n = 72), followed by anterior STEMI (34.5%, n = 57), and the least incident type was lateral STEMI (1.8%, n = 3), while Posterior, Inferolateral, Anterolateral and Posteroinferior STEMI were present in 2.4% (n = 4), 2.4% (n = 4), 10.3% (n = 17) and 4.8% (n = 8) of patients. The success rate of thrombolysis was 62.4% (n = 103), while 37.6% (n = 62) were unsuccessful. 37.0% (n = 61) had a Low EF (<40%) while the percentages and numbers of patients having a Borderline EF (41-49%) and having a Preserved EF (>50%) were 31.5% (n = 52) each. 91.5% (n = 151) of the patients did not develop MACE, 7.3% (n = 12) developed cardiovascular death, and 1.2% (n = 2) developed a non-fatal stroke. Other complications such as ventricular tachycardia/arrhythmia, cardiogenic shock, and pulmonary edema were present in 6.7% (n= 11), 15.8% (n = 26) and 4.2% (n = 7) of the patients respectively. 3% (n = 5) of the patients developed major bleeding and 19.4% (n = 32) developed minor bleeding as a complication of treatment. The study found significant associations between the demographic factors (age and sex) and the outcomes (success of thrombolytic therapy, MACE, and left ventricular impairment). All the modifiable risk factors and the nonmodifiable risk factor (family history of ischemic heart disease) also showed significant associations with the outcomes.