Abstract:
ST Elevated Myocardial Infarction (STEMI) is a life-threatening condition that requires immediate
medical care; treatments include thrombolytic therapy e.g. Streptokinase. The objective of this study was to explore the characteristics of STEMI patients associated with medication failure in the use of Streptokinase.
Method: A retrospective study was conducted in STEMI patients who were admitted to Suratthani
Hospital from 1st January 2011 to 30th June 2013. Failed Streptokinase is defined as ST resolution (STR)
<50% and ongoing chest pain >90 minutes after receiving medication. Data, including age, sex, door-toneedle
time, wall of infarction, smoking status, Killip classification, and underlying diseases such as hypertension,
were collected. Multiple logistic regression models were used to explore the association between
these covariates and failed Streptokinase, as well as each of the criteria used to define failed Streptokinase,
with a significance level of 0.05. A total number of 93 STEMI patients were identified, with a
mean age of 58. Factors significantly associated with STR <50% after 90 minutes are hypertension (OR
2.913, 95%CI: 1.014, 8.369), Killip class >1 (OR 3.057, 95%CI: 1.053, 8.878), and having anterior wall infarction
(OR 7.018, 95%CI: 2.219, 22.199). There is an association between ongoing chest pain after 90 minutes
and having anterior wall infarction (OR 5.09, 95%CI: 1.297, 19.973). Failed Streptokinase is associated with
Killip class >1 (OR 3.652, 95%CI: 1.032, 12.921) and having anterior wall infarction (OR 6.602, 95%CI 1.498,
29.089). Despite its advantages, STEMI patients with hypertension, anterior wall infarction, and Killip
class>1 may be less likely to be beneficial from using Streptokinase.
