A Comparative Study of Thrombolytics Used for The Treatment of STEMI in a South Indian Tertiary Care Hospital

Background: ST segment elevated myocardial infarction is the most common cause of mortality and morbidity in worldwide; it occurs when thrombus formation results in complete occlusion of major epicardial vessel, thrombolytics was the first choice of treatment for STEMI along with other supporting therapies. Objective: To compare safety and efficacy of thrombolytics Streptokinase, Tenecteplase and Reteplase for the treatment of STEMI. Methodology: This is a prospective observational study conducted for a period of 6 months (November 2014 to May 2015) in RMMCH, Chidambaram. A total of 90 cases were collected. Study consist of three groups, group-1 (receiving streptokinase), group-2 (receiving Reteplase) and group 3 (receiving tenecteplase). Relevant data was obtained from case sheets before and after lysis and analyzed. Result: The study identified all three fibrinolytic drugs to be efficacious in causing > 50% resolution in ST segment, symptoms relief. Safety parameters were found to be fair in Reteplase group where no side effect was observed. Hypotension and cardiovascular arrest was observed in Streptokinase and Tenecteplase respectively. Efficacy was found to be high in Reteplase group with 93% of STEMI resolution and 93% of symptomatic relief where 83 % and 90% in tenecteplase and 83% and 86% in streptokinase groups. One death was reported in streptokinase and tenecteplase group respectively. Conclusion: Reteplase was found to be most safest and efficacious drug followed by tenecteplase and streptokinase.