Neha Aherrao1,2*, Manoj Chopda2, Vaibhav Gulecha2, Vishal Gulecha1 and Chandrashekhar Upasani1
1Department of Pharmacology, SNJB’s SSDJ College of Pharmacy, Nashik, India
2Chopda Medicare & Research Centre Pvt. Ltd., Magnum Heart Institute, Canada Corner, Nashik, India
Myocardial Infarction can be defined from a number of different perspectives related to clinical, Electrocardiographic (ECG), biochemical and pathologic characteristics. It is accepted that the term Myocardial Infarction reflects death of cardiac myocytes caused by prolonged ischaemia. The ECG may show signs of myocardial ischaemia, specifically ST and T changes, as well as signs of myocardial necrosis, specifically changes in the QRS pattern. A working definition for acute evolving Myocardial Infarction in the presence of clinically appropriate symptoms has been established as - patients with ST-segment elevation, i.e. new ST-segment elevation at the J point with the cut-off points >0.2 mV in V1 through V3 and >0.1 mV in other leads. ST-elevation appears in ECG due to full thickness damage of cardiac muscle. Thus, STEMI is more severe type of myocardial infarction compared to NSTEMI (Non-ST elevation myocardial infarction) in which partial thickness damage of heart muscle develops. The most common symptom of MI is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Often it is in the center or left side of the chest and lasts for more than a few minutes. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, or feeling tired. Patients of STEMI should be considered for primary PCI (Per- Cutaneous Coronary Intervention) immediately. It is the main treatment of choice for ST-segment elevation myocardial infarction. It reduces mortality rate, infarct size and further re-infarction. But if PCI is not available of primary PCI cannot be performed within 120 minutes of diagnosis then fibrinolytic therapy is the best option. PCI is superior to fibrinolytic therapy in circumstances where there is an immediate access to skilled facility and physician/health care teams. If this is not available, then fibrinolytic therapy is an effective alternative. The benefits of thrombolytic therapy in patients with acute myocardial infarction are well established. The benefit of thrombolytic therapy is very time dependent. Major benefit is seen in those patients who present within 3 hr of the onset of symptoms. Thrombolytic therapy can also be administered to the patients presenting within 12 hr of symptoms. Thrombolytics recanalize thrombotic occlusion associated with ST-segment Elevation Myocardial Infarction (STEMI) and restoration of coronary flow reduces infarct size and improves myocardial function and survival over the short term and long-term. Complete restoration of coronary flow is the principal mechanism by which reperfusion therapy improves survival and other clinical outcomes in subjects with acute myocardial infarction in whom there is electrocardiograph evidence of ST-segment elevation. Intravenous thrombolytic therapy is, however, the standard of care for subjects with acute myocardial infarction, because of its widespread availability, its ability to reduce mortality, and its use in more than a million subjects over the past decade.
Streptokinase; Tenecteplase; STEMI; TIMI Flow
Aherrao N, Chopda M, Gulecha V, Gulecha V, Upasani C. A Randomized, Parallel Study to Compare Efficacy & Safety of Streptokinase vs Tenecteplase when Given in Correct Timelines in Patients of ST-Elevation Myocardial Infarction (STEMI). Ann Pharmacol Pharm. 2018; 3(5): 1159.