Bawaskar Himmatrao S, Bawaskar Pramodini H, Bawaskar Parag H
Department of Medicine, Bawaskar Hospital and Clinical Research Center, Mahad Raigad, Maharashtra, India.
Department of Cardiology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India.
J Family Med Prim Care. 2019 Jan;8(1):62-71. doi: 10.4103/jfmpc.jfmpc_297_18.
Coronary artery disease is a major cause of death in India. Sudden death preceded by chest pain is due to acute myocardial infarction. Villagers are aware and afraid of chest pain. Majority of chest pain victims attend the primary physician in golden hours. Hence, primary doctors can play important role for early thrombolysis and salvage the myocardium from irreversible injury. This study determined year mortality in a patient who received the rapid thrombolysis at primary care hospital (streptokinase or tenecteplase) at rural setting.
Peripheral General Hospital Mahad on Mumbai-Goa highway.
Patients with typical chest pain with electrocardiogram showed ST segment elevated myocardial infarction (STEMI) with or without risk factors admitted from 2005 to march 2016 were studied. Details clinically studied: time interval between chest pain to hospital, hospital to needle time, reperfusion and arrhythmias. Time required for regression of elevated ST segment, a response to thrombolytic (streptokinase or tenecteplase) therapy, is studied.
Total 244 patient reported with chest pain of these 35 cases brought dead with history of chest pain and convulsive moment before they died. Of these, 209 patients had acute STEMI. Of these, 162 received streptokinase (STK) and 47 received tenecteplase (TNP)]. Analysis of STK Vs TNP patients 18 (11.11%) versus 3 (6.38%) ( = 0.361) died during the treatment. Around 17 (18.49%) vs 5 (10.63%) ( = 0.941) did not show signs of reperfusion, respectively. Re infarction occurred during hospitalization 3 (2.5%) versus 3 (6.38%) ( = 0.094) cases. Around 12 (7.40%) versus 0% ( = 0.072) died at the end of 12 months of thrombolytic therapy.
Thrombolysis of STEMI within golden hours improved the reperfusion. However, 1-year fatality is significance with streptokinase as compared with tenecteplase.
冠状动脉疾病是印度主要的死亡原因。胸痛后猝死多因急性心肌梗死所致。村民们知晓并惧怕胸痛。大多数胸痛患者会在黄金时段前往基层医生处就诊。因此，基层医生在早期溶栓及挽救心肌免受不可逆损伤方面可发挥重要作用。本研究测定了在农村地区基层医疗医院接受快速溶栓治疗（链激酶或替奈普酶）的患者的年度死亡率。
位于孟买 - 果阿高速公路上的马哈德外周综合医院。
对2005年至2016年3月期间收治的有典型胸痛且心电图显示ST段抬高型心肌梗死（STEMI）、有或无危险因素的患者进行研究。临床研究细节包括：胸痛至入院的时间间隔、入院至用药时间、再灌注情况及心律失常情况。研究了ST段抬高恢复所需时间，这是对溶栓治疗（链激酶或替奈普酶）的一种反应。
共有244例患者出现胸痛，其中35例在胸痛发作且死前有抽搐症状，送来时已死亡。在这些患者中，209例患有急性STEMI。其中，162例接受了链激酶（STK）治疗，47例接受了替奈普酶（TNP）治疗。分析STK组与TNP组患者，治疗期间死亡人数分别为18例（11.11%）和3例（6.38%）（P = 0.361）。未显示再灌注迹象的患者分别为17例（18.49%）和5例（10.63%）（P = 0.941）。住院期间再梗死发生情况分别为3例（2.5%）和3例（6.38%）（P = 0.094）。溶栓治疗12个月结束时死亡人数分别为12例（7.40%）和0例（P = 0.072）。
在黄金时段对STEMI进行溶栓可改善再灌注情况。然而，与替奈普酶相比，链激酶治疗1年时的死亡率较高。
