Original Article

The Effect of the Door to Needle Time of Streptokinase Administration on the QTc Interval and the Incidence of Life-Threatening Arrhythmia in Patients With Anterior Myocardial Infarction

Abstract

Early administration of thrombolytic agents is standard for patients presenting with acute myocardial infarction (MI). Also, prolonged QT intervals indicate a higher risk for sudden death in patients with MI. This study was conducted to evaluate the door to needle time of streptokinase administration and the incidence of life-threatening arrhythmia in patients with anterior MI. This study was a prospective, single-center study on participants with anterior MI, who were divided into streptokinase and non-streptokinase groups. After administration of streptokinase, QTc was measured in hyper-acute, acute, and recent phases of anterior MI in the group and compared with acute and recent phases in the non-streptokinase group. The incidence of life-threatening arrhythmia was measured and compared in two groups. The data were analyzed by descriptive statistics method and variance analysis in the SPSS software, version 22. The level of significance was considered to be 0.05. Among 87 participants, there was a significant relationship between the door to needle time of 30 minutes and QTc interval in the hyperacute phase (P=0.005). Also, QTc in the streptokinase group was significantly lower than the non-streptokinase group in the acute phase (P=0.003 vs. P=0.205) and recent phase (P=0.007 vs. P=0.228). The incidence of fatal arrhythmias in the streptokinase group was lower than in the others. The relationship between the incidence of VT/VF and TIMI flow grade was insignificant (P=0.089). Reduction of the door to needle time after anterior MI has significant effects on QTc and incidence of threatening arrhythmia.

1. Younessi Heravi MA, Mojdekanlu M, Seyed Sharifi SH, Yaghubi M. The role of cardiovascular risk factors in the involvement of coronary arteries; A predictive model in the angiographic study. Journal of North Khorasan University of Medical Sciences. 2014;6(1): 199-205.
2. Younessi Heravi MA, Yaghubi M, Joharinia S. Effect of change in patient’s bed angles on pain after coronary angiography according to vital signals. J Res Med Sci. 2015; 20:937-43.
3. Eshraghi A, Rezaei S, Yaghubi M. Risk Factors of Increased Corrected TIMI Frame Count in Angioplasty of Culprit Lesion after non-ST Elevation Acute Coronary Syndrome. Archives of Pharmacy Practice. 2020; 11 (S1): 141-148.
4. Ghaffari S, Kazemi B, Golzari IG. Efficacy of a New Accelerated Streptokinase Regime in Acute Myocardial Infarction: A Double Blind Randomized Clinical Trial. Cardiovasc Ther. 2013;31(1):53-59.
5. Abba AA, Wani BA, Rahmatullah RA, Khalil MZ, Kumo AM, Ghonaim MA. The door to needle time in administering thrombolytic therapy for acute myocardial infarction. Saudi Med J. 2003;24(4):361-4.
6. Boersma E, Maas AC, Deckers JW, Simoons ML. Early thrombolytic treatment in acute myocardial infarction: Reappraisal of the golden hour. Lancet 1996; 9030: 771-775. 7. Timm TC, Ross R, Braunwald E. Left ventricular function.
7. Straus SM, Kors JA, De Bruin ML, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol. 2006; 47: 362-7.
8. Zhang Y, Post WS, Dalal D, et al. QT-interval duration and mortality rate: results from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2011; 171: 1727-33.
9. Beinart R, Zhang Y, Lima JA, et al. The QT interval is associated with incident cardiovascular events: the MESA study. J Am Coll Cardiol. 2014; 64: 2111–9.
10. Peters RW, Byington RP, Barker A, et al. Prognostic value of prolonged ventricular repolarization following myocardial infarction: the BHAT experience. The BHAT Study Group. J Clin Epidemiol. 1990; 43: 167-72.
11. Schwartz PJ, Wolf S. QT interval prolongation as a predictor of sudden death in patients with myocardial infarction. Circulation. 1978; 57: 1074-7.
12. Lin JF, Hsu SY, Wu S, Teng MS, Chou HH, Cheng ST, Wu TY, Ko YL. QT interval Independently Predicts Mortality and Heart Failure in Patients with ST-Elevation Myocardial Infarction. Int. J. Med. Sci. 2015; 12(12): 968-973.
13. Williams ES, Thomas KL, Broderick S, et al. Race and gender variation in the QT interval and its association with mortality in patients with coronary artery disease: results from the Duke Databank for Cardiovascular Disease (DDCD). Am Heart J. 2012; 164: 434-41.
14. Montanez A, Ruskin JN, Hebert PR, et al. Prolonged QTc interval and risks of total and cardiovascular mortality and sudden death in the general population: a review and qualitative overview of the prospective cohort studies. Arch Intern Med. 2004; 164: 943-8.
15. Rahimi Darabad B, Vatandust J, Pourmousavi Khoshknab MM, Seyed Mohammad Zad MH. Survey of the effect of streptokinase on ventricular repolarization by examining the QT dispersion in patients with the acute myocardial infarction in Seyed-Al-Shohada hospital, Urmia. Glob J Health Sci. 2014;18; 6:74-82.
16. Nikiforos, S., Hatzisavvas, J., Pavlides, G., Voudris, V., Vassilikos, V. P., Manginas, A., et al. QT-interval dispersion in acute myocardial infarction is only shortened by thrombolysis in myocardial infarction gradem 2/3 reperfusion. Clin Cardiol. 2003; 26(6): 291-295.
17. Chander, S., Kumar, R., Jorapur, V., Desai, N., Rao, M., & Yeragani, V. K. Effect of mechanical coronary reperfusion on QT dispersion in acute coronary syndrome. Indian heart journal. 2004; 57(3),233-236.
18. Moreno, F. L., Villanueva, T., Karagounis, L. A., & Anderson, J. L. Reduction in QT interval dispersion by successful thrombolytic therapy in acute myocardial infarction, TEAM-2 Study Investigators. Circulation. 1994; 90(1), 94-100.
19. Newby LK, Rutsch WR, Califf RM, Simoons ML, Aylward PE, Armstrong PW, Woodlief LH, Lee KL, Topol EJ, Van de Werf F. Time from symptom onset to treatment and outcomes after thrombolytic therapy. GUSTO-1 Investigators. J Am Coll Cardiol. 1996; 27:1646–1655.
20. McNamara RL, Herrin J, Wang Y, Curtis JP, Bradley EH, Magid DJ, and et al. Impact of Delay in Door-to-Needle Time on Mortality in Patients with ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2007;100(8):1227-1232.
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IssueVol 60, No 3 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/acta.v60i3.9001
Keywords
Anterior wall myocardial infarction Streptokinase Electrocardiography
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How to Cite
1.
Ghasemi R, Vojdanparast M, Hosseinzadeh Maleki M, Yaghubi M. The Effect of the Door to Needle Time of Streptokinase Administration on the QTc Interval and the Incidence of Life-Threatening Arrhythmia in Patients With Anterior Myocardial Infarction. Acta Med Iran. 2022;60(3):144-149.