Fibrinolytic activity in patients with atrial arrhythmias during acute myocardial infarction, treated with streptokinase
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KeywordsAtrial Fibrillation Acute Myocardial Infarction Pulmonary Edema Acute Myocardial Infarction Streptokinase
Increased level of plasminogen-activator-inhibitor-1 (PAI-1) reflects impaired fibrinolytic activity and is associated with increased risk for failed fibrinolysis with fibrinolytic agents, including with streptokinase (STK). Atrial arrhythmias (AA) in patients with acute myocardial infarction (AMI) are associated with heart failure and increased mortality. The prognostic role of pre-treatment PAI-1 activity in patients with AA and AMI, treated with STK was evaluated.
In patients with AMI, treated with streptokinase, pre-treatment PAI-1 levels were estimated by chromogenic method (normal levels 0.5–3.5 U/ml) and the presence or absence of AA assessed. Included were atrial fibrillation and/or flutter and/or tachycardias. We compared pre-treatment variables (PAI-1 included) and in-hospital events in patients with and without AA.
AA were found in 22.4% (26/116) of patients. Among pre-treatment variables, the only statistically significant difference between patients with and without AA was observed in mean pre-treatment PAI-1 levels (P = 0.0017). PAI-1 level over 7 U/ml was the most significant independent risk factor for AA (P < 0.05, OR 3.5, 95% CI 1.15–10.6). AA were significantly associated with cardiogenic shock, pulmonary edema, cardiopulmonary resuscitation after STK, conduction disturbances and mortality. In-hospital mortality of patient with AA was 23% and 4% without them (OR 6.45, 95% CI 1.66–25.017). Among in-hospital events, cardiogenic shock was the most significant independent predictor of AA.
AA in patients with AMI, treated with streptokinase, were associated with elevated mean pre-treatment PAI-1 levels and increased mortality due to heart failure. Pre-treatment PAI-1 over 7 U/ml was the only independent significant risk for AA during AMI.