Outcomes of treatment between streptokinase at the community hospital and primary PCI at tertiary care hospital for STEMI patients, Suratthani, Thailand

Outcomes of treatment between streptokinase at the community hospital and primary PCI at tertiary care hospital for STEMI patients, Suratthani, Thailand ABSTRACT

Background:
Acute ST-segment elevation myocardial infarction (STEMI), due to sudden coronary artery occlusion, is one of the most life-threatening diseases in the Thailand. Although extensive efforts have been taken to greatly minimize mortality and benefit STEMI patients, a gap between the guidelines and implementation in the real word practice. This article was study about the benefit of reperfusion strategy in STEMI care in community hospital between primary PCI in tertiary care center, and also introduces what we will do to bridge the gap through the upcoming STEMI guideline and reperfusion program of community hospital in Thailalnd. AIM: To compare the outcomes of streptokinase (SK) at the community hospital and primary percutaneous coronary intervention (primary PCI) at the tertiary hospital among ST-segment elevation myocardial infarction (STEMI) patients

Methods
A retrospective cohort study was conducted at Suratthani hospital in 2016.

Results
Overall 191 STEMI patients. The electrocardiography (EKG) was classified as anterior wall of 103 (53.4%) and inferior wall of 49 (25.4%). Ninety-one (47.6%) patients were treated with SK. The mean ± SD of door to SK time was 200 ± 132 minutes. Compared to SK, primary PCI had more chronic kidney disease (12% vs. 1.1%, P=0.003), higher Killip Class 3 (8% vs. 0%, P=0.007), higher cardiac arrest on admission (9% vs. 0%, P=0.003) but lesser length of hospitalization (median, 3 vs. 2 days , P=0.005). No difference of major bleeding (4% vs. 2.2%, P=0.68) and Intracranial hemorrhage (2.2% vs. 0%, P=0.230) complication. The in-hospital mortality in the primary PCI group was higher (11% vs 1.1%, P=0.005)

Conclusions
Streptokinase is effective treatment in STEMT patient who present at community hospital. In-hospital mortality of STEMI patients treated with primary PCI in tertiary care center was higher compared to SK in the community hospital. However, the primary PCI group was more severe illness at presentation than the SK group.