Clinical Pharmacology & Biopharmaceutics
Open Access

Abstract

Introduction: Acute myocardial infarction (AMI) represents a serious problem in the current medical practice, for many reasons, such as: increase in incidence, especially in those who are under 45 years old, and also with a high mortality rate (50% mortality in the first month of which half of the mortality is in the first 2 hours since onset) without a promptly and appropriate treatment; however, monitoring costs and long-term treatment are very expensive. In the United States, the annual death toll from coronary heart disease is higher than 800,000. More than 1 million people each year in the United States sustain an acute MI. In Romania, this is about 150,000 AMI in each year. In the 1998 year, mortality due to AMI was 98 per 100,000 people, twice as 1988 year. Mortality is extremely high, especially in the presence of cardiogenic shock, despite treatment becoming more aggressive. Purpose and hypothesis work. In this study the authors try to demonstrate that using three non-invasive markers [Troponin I (TnI), CK-MB, and resolution of ST elevation on ECG], the efficiency of thrombolysis in patients with ST elevation MI (STEMI) can be properly assessed. In the same time, the prognostic can be predicted. Materials and methods: 30 patients with STEMI admitted in emergency department (ED) were studied, successively during 01.09.2011-29.02.2012. All subjects received thrombolytic therapy with tenecteplase (TNK). The dose regimen of TNK was 0.5 mg/kg, a single bolus intravenously. In each patient, the values of CK-MB, TnI and ECG trace were determined during the hospital admission in the following manner: before and immediately after thrombolysis, and after 24 hours since the subjects arrived in ED. CK-MB and TnI were determined using a device called Pathfast. Obviously, other parameters were also determined in all these patients. The statistical data was processed with χ2 test. Results and discussions: Of all the 30 patients who presented to the ED, 24 patients were males (80%) and 6 patients were females (20%). Most patients belonged to the age group of 51-60 years and 71-80 years (about 30% for each age group) and 20% (6 patients) were under 50 years. Notable complications were: cardiogenic shock in 3 patients (10%). Most common location of STEMI was inferior 53.33% (16 patients). The thrombolytic therapy was initiated in 43.33% (13 patients) within 2-4 hours, 33.33% (10 patients) after 4 hours, and 16.67% (5 patients) between 1-2 hours after arrival in the ED. The thrombolytic therapy was performed in less than 60 min in only 2 patients. Evolution of the 3 markers was studied as follows: mean TnI at admission was 0.584±0.167 (VN<0.02 ng/ml) and 0.226±0.108 after thrombolysis, with a standard error (SE) of 2.14. In fact, elevated TnI at admission correlates with the onset of STEMI, less than 3 hours after arrival in the ED. Mean CK-MB at admission were 21.18±8.09 (VN = 0.34 to 4.99 ng/ml) and 13.85±8.10 after thrombolytic treatment with a SE of 0.91. ST elevation average (mm) on admission was 4.10±1.61 and 2.60±1.27 after thrombolysis, with an SE of 0.93%. There was a significant resolution of ST segment elevation after thrombolysis. No bleeding complications such as cerebral hemorrhage were recorded, and no deaths were noted in this group of patients that were evaluated. Conclusions: In many cases, there was no availability (or eligibility) of coronary artery bypass grafting (CABG) or primary percutaneous coronary intervention (PCI) with the stent implantation procedures. In the ED we can assess the effectiveness of thrombolysis using these three non-invasive markers, relatively easy to obtain, in any hospital with an emergency profile. Data shows the non-invasive measurements of the effectiveness of thrombolysis, and the crucial importance of early initiation of this therapy, soon as possible after arrival of the patients in the emergency department.

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