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Impact of type of thrombolytic agent on in-hospital outcomes in ST-segment elevation myocardial infarction patients in the Middle East

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Abstract

Little is known about the impact of thrombolytic agents on in-hospital outcomes in the Middle East. The objective of this study was to evaluate the impact of thrombolytic agents on in-hospital outcomes in ST-segment elevation myocardial infarction (STEMI) patients in six Middle Eastern countries. Gulf Registry of Acute Coronary Events was a prospective, multinational, multicentre, observational survey of consecutive acute coronary syndrome patients admitted to 65 hospitals in 2006 and 2007. Out of 1,765 STEMI patients admitted to hospitals within 12 h of symptoms onset, 25, 43, and 30% were treated with streptokinase, reteplase, and tenecteplase, respectively. Median age of the study cohort was 50 (45–59) years and majority were males (89%). The overall median symptom onset-to-presentation and median door-to-needle times were 130 min (65–240) and 45 min (30–75), respectively. Streptokinase patients had worse GRACE risk scores compared to patients who received fibrin specific thrombolytics. Academic hospitals and cardiologists as admitting physicians were associated with the use of fibrin specific thrombolytics. After significant covariate adjustment, both reteplase [odds ratio (OR), 0.38; 95% CI: 0.18–0.79; P = 0.009] and tenecteplase (OR, 0.30; 95% CI: 0.12–0.77; P = 0.012) were associated with lower all-cause in-hospital mortality compared with streptokinase. No significant differences in other in-hospital outcomes were noted between the thrombolytic agents. In conclusion, in light of the study’s limitations, fibrin specific agents, reteplase and tenecteplase, were associated with lower all-cause in-hospital mortality compared to the non-specific fibrin agent, streptokinase. However, the type of thrombolytic agent used did not influence other in-hospital outcomes.

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Acknowledgments

Gulf RACE was sponsored by the Gulf Heart Association and was financially supported by a grant from Sanofi Aventis and Qatar Telecommunications Company. The financial sponsors had no role in study design, data collection, data analysis, writing of the report or submission of the manuscript. The authors declare no conflicts of interest with respect to the authorship and/or publication of this article. The authors would like to thank the patients, physicians, nurses, and support staff who participated in Gulf RACE registry for their invaluable contribution and cooperation.

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Authors and Affiliations

  1. Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 38, Al-Khodh, Muscat, 123, Sultanate of Oman

    Ibrahim Al-Zakwani

  2. Gulf Health Research, Muscat, Sultanate of Oman

    Ibrahim Al-Zakwani

  3. Department of Medicine, Mubarak Alkabeer Hospital, Ministry of Health, Kuwait City, Kuwait

    Amr Ali

  4. Department of Medicine, Kuwait University, Kuwait City, Kuwait

    Mohammad Zubaid

  5. Department of Cardiology, Royal Hospital, Muscat, Sultanate of Oman

    Prashanth Panduranga & Kadhim Sulaiman

  6. Department of Pharmacy Practice, School of Pharmacy, College of Pharmacy & Nursing, University of Nizwa, Nizwa, Sultanate of Oman

    Ahmed Abusham

  7. Division of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates

    Wael Almahmeed

  8. Department of Medicine, Faculty of Medicine, Sana’a University, Sana’a, Yemen

    Ahmed Al-Motarreb

  9. Division of Cardiology, Hamad Medical Corporation, Doha, Qatar

    Jassim Al Suwaidi

  10. Mohammed Bin Khalifa Cardiac Center, Manama, Bahrain

    Haitham Amin

Authors
  1. Ibrahim Al-Zakwani
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  2. Amr Ali
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  3. Mohammad Zubaid
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  4. Prashanth Panduranga
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  6. Ahmed Abusham
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  7. Wael Almahmeed
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  8. Ahmed Al-Motarreb
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  9. Jassim Al Suwaidi
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Correspondence to Ibrahim Al-Zakwani.

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Al-Zakwani, I., Ali, A., Zubaid, M. et al. Impact of type of thrombolytic agent on in-hospital outcomes in ST-segment elevation myocardial infarction patients in the Middle East. J Thromb Thrombolysis 33, 280–286 (2012). https://doi.org/10.1007/s11239-012-0698-6

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  • DOI: https://doi.org/10.1007/s11239-012-0698-6

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