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The main goal of treatment of acute coronary syndrome with ST segment elevation is the quick restoration of TIMI 3 coronary blood flow and myocardial perfusion in the infarcted area. This reperfusion can be provided by either a pharmacological strategy (Fibrinolysis) or mechanical (PCI). The choice between the two strategies is most often based on local possibilities. The objective of this work is to evaluate the impact of delays between the onset of chest pain and the first medical contact on the angiographic results of fibrinolysis.
Among the 1049 patients thrombolysed within 12 hours of onset of STEMI symptoms, we selected 378 patients with mono-vessel coronary disease at coronary angiography that was performed within 24 hours after thrombolysis. Patients were divided into six (06) groups based on their times of arriving by intervals of 2 hours.
The average age of the population was 55.7 ± 8.07 years, the average time between the onset of chest pain and arrival at the hospital was 319 ± 186 minutes. All patients were thrombolysed as recommended in less than 30 minutes from the first medical contact, with a mean of 18.4 ± 4,7mn, and the rate of permeable coronary arteries with TIMI 3 flow was 76% . There were no significant differences between the six (06) study groups on demographic and epidemiological characteristics. However, the rate of permeable culprit arteries with TIMI 3 flow was significantly higher in the group of patients thrombolysed within 2 hours (94.4%; p <0.001; df: 5). This rate gradually decreased by the prolongation of delays before admission 44.1% of patients in the thrombolysed group between the 10th and 12th hour. There is an inverse correlation between the rate of TIMI 3 flow and arrival time at the hospital (r = - 0.282, p = 0.001). The rate of bleeding complications was lower in this young population (<70 years), with 7 patients (1.85%) who presented only minor bleeding.
All studies comparing fibrinolysis to primary angioplasty are consistent, mechanical reperfusion is better than thrombolysis which is relegated to second intention if recommended delays for angioplasty are exceeded. However, in real life, patients do not all arrive during the “golden hour” and hospital structures do not all have a technical platform ensuring primary angioplasty 24h/24h. We have demonstrated in our work, the results of thrombolysis may be influenced by the time between the onset of pain and first medical contact. Results similar to those of primary angioplasty are found in patients consulting in the first 2h (94.4% of TIMI flow 3) without major bleeding.
CORONARY: Acute Myocardial Infarction