Benefit of the early use of tissue plasminogen activator (Alteplase) in the management of acute myocardial infarction
Ayad Arrak Mekhlif
Background: ST segment elevation myocardial infarction (STEMI) result from complete occlusion of coronary artery following atherosclerotic plaque rupture and subsequent thrombosis. Pharmacological thrombolysis by tissue plasminogen activator (t-PA) Alteplase, which is the first generation recombinant t-PA convert plasminogen to plasmin and mimicking endogenous t- pA and thereby precipitating thrombolysis and induce patency in the infarction related vessel (IRV).Objective: This study aims to assess the benefit of early use of tissue plasminogen activator (Alteplase) in the management of acute myocardial infarction (AMI).Material and Method: 20 patient 4 femals and 16 males were enrolled, 13 of them within first 6 hrs of severe chest pain consistent with acute MI, and 7 of them within 2nd 6 hrs of the symptoms, accompanied by an ECG ST- elevation where randomly assigned to weght adjusted, accelerated infusion of 100mg. of Alteplase. The rate of success is assessed by 2 parameter: ECG and by biochemical cardiac markers CK MB isoenzyme before and 90 minutes after Alteplase infusion, which is regarded by my study as equivalent to assessment of restoration of the blood flow 9 (reperfusion) by angiography by GUSTO1 trial.Result: Complete reperfusion was achieved in about 45% of patient assessed by EC Gand in about 40%of patient as assessed by biochemical cardiac markers CK-MB. High prevalence of positive (53-84%) was achieved among patient within first six hrs of symptoms of total patient benefit from treatment.Conclusion: As compared with GUSTO1 trial accelerated infusion of alteplase over period of 90 mint. Considered an excellent method for myocardial l reperfusion and appears to induce re-canalization if used within 12 hrs. Dramatic response occur during first 6 hrs after symptoms of acute MI with high rate of patency in infarction related vessels. (IRV).