Some Aspects of Prehospital Thrombolytic Therapy in the Perm Region
Aim. To study data on prehospital thrombolytic therapy in ST elevation myocardial infarction (STEMI) in the Perm Krai, its efficacy and safety. Material and methods. The retrospective analysis using the official statistics and medical records of the emergency medical service, primary vascular department and regional vascular center for 2014-2017 was performed. Patients with a history of myocardial infarction in the period from 2015 to the 1 st quarter of 2017 were included into the study. Medical records of 65 people with STEMI were studied. Patients were divided into two groups: Group I (n=27) - STEMI with thrombolytic therapy with recombinant staphylokinase; Group II (n=38) - STEMI with thrombolytic therapy with tenecteplase. Indirect signs of the efficacy of thrombolytic therapy, the degree of restoration of blood flow in the infarct-related artery according to coronary angiography, and the development of complications were analyzed. Data on general clinical and echocardiographic studies were collected. A telephone survey of patients was conducted to assess the long-term outcomes at the second stage. Results. Increase in the number of prehospital thrombolytic therapy for acute coronary syndrome with ST elevation for 2014-2017 was found according to medical reports. A change in the proportion of the shares of prehospital thrombolytic therapy and percutaneous coronary intervention was also found. Recombinant staphylokinase was comparable to tenecteplase in efficacy and safety in STEMI patients in the first 12 hours. Large bleeding occurred in 1 (3.7%) case with recombinant staphylokinase and in 2 (5.3%) cases with tenecteplase. The number of life-threatening reperfusion arrhythmias was also comparable: 1 patient per each Group. Telephone contact was established with 21 (77.8%) and 30 (78.9%) patients in Groups, respectively. Relapse of angina was found among the interviewed patients in 3 and 5 cases in Groups, and decompensation of heart failure in 2 patients from Group I, 1 patient in each Group underwent coronary bypass surgery. Conclusion. The accumulation and processing of data on the efficacy and safety of thrombolytic therapy with recombinant staphylokinase and tenecteplase is clinically justified.