Predictors of Successful Thrombolysis in an Acute Myocardial Infarction.

The choice between thrombolysis and primary angioplasty in an acute myocardial infarction (MI) is still a topic of discussion. The objective of our study is to determine the predictive factors of success of thrombolysis in order to facilitate the choice of the therapeutic strategy in front of a MI. This is a study that included 525 patients (433 men and 92 women) thrombolyzed in the acute phase of Acute Coronary Syndromes with ST segment elevation and hospitalized in Fattouma Hospital's B Cardiology Monastir from January 1998 to September 2015. Factors influencing the response to thrombolytic therapy were investigated and a regression of the ST segment ≥ 50% at one hour after thrombolysis was selected as a re-perfusion criterion. Sex, age > 75 years, renal insufficiency and Killip IV heart failure would not be predictive of thrombolysis failure with P equals 0.609; 0.33; 0.081; 0.459,respectively. Anemia, diabetes, high blood pressure and the use of an inotropic agent at admission would be predictive of thrombolysis failure with p equal respectively to 0.03; 0.007; 0.002; < 0.001. Tobacco was also identified as a predictor of the success of fibrinolysis in patients presenting MI (74% vs. 59.8%, P = 0.001). Thrombolysis in less than 4 hours is also a predictor of success (46.8% vs. 27%, P < 0.001). In multivariate analysis, Hypertension (HR = 0.595, 95% CI 0.171–0.970, P = 0.037) and the use of inotropic drugs (HR = 0.293, 95% CI 0.171–0.504, P < 0.001) would be two independent factors of thrombolysis failure. A thrombolysis time of less than 4 hours is a predictive factor of success (HR = 0.516, 95% CI 0.329-0.809, P = 0.004). Hypertensive patients and those who required inotropes in the acute phase are less responsive to thrombolytic therapy. During the reperfusion strategy decision, the time factor with a delay of less than 4 hours is decisive in predicting the good results of fibrinolysis. [ABSTRACT FROM AUTHOR]