COMPARISON OF EFFECT OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION WITH STREPTOKINASE IN ACUTE ST ELEVATION MYOCARDIAL INFARCTION (STEMI) ON LEFT VENTRICULAR FUNCTION AFTER 3 MONTHS

Objective: To assess the left ventricular function three months after the primary percutaneous coronary intervention versus Streptokinase in ST elevation myocardial infarction. Study Design: Prospective comparative study. Place and Duration of Study: Cardiac Catheterization Lab, in-patients and out patients departments of Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from Jun 2018 to Jun 2019. Methodology: Patients included in the study were with first acute MI treated with primary PCI/SK, having systolic blood pressure >90 mmhg, pre-infarction EF >40% and with no previous history of coronary artery bypass grafting or angioplasty. All patients undergoing primary percutaneous coronary intervention/Streptokinase injection were assessed for left ventricular function at day one by transthoracic echocardiography and then three months later by transthoracic echocardiography. Two-dimensional echocardiography was being performed immediately after primary percutaneous coronary intervention on day one and at three months follow-up. Results: There were 80 patients recruited in the study. Mean age of the patients was 55.5 ± 11.6 years with range 36-81 years. Sixty nine (86.3%) patients were male while 11 (13.48%) were female patients. Most common comorbid was smoking 37 (46.3%) followed by diabetes mellitus 25 (31.3%). Most common culprit artery was left anterior descending 38 (47.5%) followed by left circumflex 15 (18.8%) and then right coronary artery 14 (17.5%). Independent sample t-test was applied to find out the statistical significance between two groups (Streptokinase group vs PPCI group). Ejection fraction of the patients was checked at the time of discharge and after three months follow-up and result showed the statistical significance with p-value <0.05. Conclusion: Based on this comparative analysis of improvement of left ventricular function between streptokinase and primary percutaneous coronary intervention, we concluded that after three months satisfactory ejection fraction is seen in patients treated with primary percutaneous coronary intervention as compared to patients treated with streptokinase.