Frequency of ST-segment resolution after thrombolysisin acute stelevation myocardial infarction patients


  • Gulshan Ahmad Punjab Institute of Cardiology, Lahore
  • Samar Arfeen Punjab Institute of Cardiology, Lahore, Pakistan
  • Shahzad Khatti Tabba Heart Institute, Karachi
  • Zain Mehmood Butt Wazirabad Institute of Cardiology, Wazirabad, Pakistan
  • Khurshid Ali Punjab Institute of Cardiology, Lahore, Pakistan
  • Saleem Ullah National Institute of Cardiovascular Diseases, Karachi - Pakistan



ST-elevation myocardial infarction, streptokinase, ST- segment resolution


Background: Acute Coronary Syndrome (ACS) is the term collectively used for referring to clinical manifestations of myocardium ischemia which include unstable angina, myocardial infarction with non-ST-segment elevation and myocardial infarction with ST-segment elevation.1 Myocardial Infarction (STEMI) is characterized by ST elevation presented on the ECG, that is the electrical presentation of the occlusion due to thrombosis in a coronary artery. After the fibrinolytic therapy in STEMI cases, the resolution of ST-segment is analyzed on ECG which serves as easy and cost-effective solution for the assessment of coronary reperfusion. In a study, it is found that 61.5% patients of STEMI showed ST-resolution after streptokinase.


Aims and Objective: To determine the frequency of ST-segment resolution after streptokinase in acute STEMI patients.


Materials and Methods: This cross-sectional study was carried out from 08-07- 2016 to 07-01-2017.After taking approval from ethical committee and explaining the procedure informed consent was taken. Ninety-two (92) patients were recruited from emergency Department of Tabba Heart Institute Karachi on the basis of inclusion/exclusion criteria via non-probability consecutive sampling technique. ECGs were taken at presentation. ST-elevation was recorded in millimeters in lead with maximum ST-elevation. Injection streptokinase was administered. ECG was performed after 60 minutes of infusion of injection streptokinase. ST resolution in the lead with the maximum ST elevation was noted and was labeled as positive as per operational definition.


Results: The range of the age in this study was from 25 to 80 years with mean age of 54.9 ± 4.8 years. Out of 92 patients, 56(60.9%) were male and 36(39.1%) were female. Regarding ECG changes sixty patients (71.7%) were successfully resolved after streptokinase in acute STEMI patients while in twenty-six patients (28.3%) could not resolve.


Conclusion: Successfully resolution of ECG changes seen in 71.7% patients after streptokinase in acute STEMI patients while could not be resolved in 28.3% patients. Thus, streptokinase could be preferred therapy for thrombolysis in STEMI.


Keywords: ST-elevation myocardial infarction, streptokinase, ST- segment resolution.

Author Biographies

Gulshan Ahmad, Punjab Institute of Cardiology, Lahore

Senior Registrar Cardiology

Samar Arfeen, Punjab Institute of Cardiology, Lahore, Pakistan

Senior Registrar Cardiology

Shahzad Khatti, Tabba Heart Institute, Karachi

Senior Registrar Cardiology

Zain Mehmood Butt, Wazirabad Institute of Cardiology, Wazirabad, Pakistan

Senior Registrar Cardiology

Khurshid Ali, Punjab Institute of Cardiology, Lahore, Pakistan

Senior Registrar Cardiology

Saleem Ullah, National Institute of Cardiovascular Diseases, Karachi - Pakistan

Senior Registrar Cardiology


Lemos JA, Braunwald E. St segment resolution as a tool for assessing the efficacy of reperfusion therapy. J Am CollCardiol. 2001; 38(5):1283-94.

Masoomi M, Samadi S, Sheikhvatam M. Thrombolytic effect of streptokinase infusion assessed by St-segment resolution between diabetic and non-diabetic myocardial infarction patients. Cardio J. 2012;19(2): 168-73.

Shuja-ur-Rehman, Sheikh S, Nazeer M. St-segment resolution post MI-A predictor of better outcomes. J Pak Med Assoc. 2008 May;58(5): 283-286.

Bhatia L, Clesham GJ, Tumer DR. Clinical implications of ST-segment non-resolution after thrombolysis for myocardial infarction. J R Soc Med 2004; 97:566-70.

Sultana R, Sultana N, Rasheed A, Rasheed Z, Ahmed M, Muhammad Ishaq, et al. Door to needle time of streptokinase and St segment resolution assessing the efficacy of repurfusiontheraphy. J Ayub Med Coll Abbottabad. 2010;22(1): 150-53.

Harkness JR, Sabatine MS, Braunwald E, Morrow DA, Sloan S, Wiviott SD, et al. Extent of ST-segment resolution after fibrinolysis adds improved risk stratification to clinical risk score for ST-segment elevation myocardial infarction. Am Heart J. 2010;59(1):55-62.

Bowry AD, Lewey J, Dugani SB, Choudhry NK. The Burden of Cardiovascular Disease in Low- and Middle-Income Countries: Epidemiology and Management. Can J Cardiol. 2015 Sep;31(9):1151-9. doi: 10.1016/j.cjca.2015.06.028. Epub 2015 Jul 3. PMID: 26321437.

Loch A, Lwin T, Zakaria IM, ZainalAbidin A, Azman W, Wan Ahmed W, et al. Failure to improve door to needle time by switching to emergency physician initiated thrombolysis for ST-elevation myocardial infarction. Postgrad Med J. 2013;89:335-39. Doi: 10.1136/postgradmedj-2012-131174.

Le May MR, Wells GA, Labinaz M. Combined angioplasty and pharmacological intervention versus thrombolysis alone in acute myocardial infarction (CAPITAL AMI study) J Am CollCardiol. 2005;46:417–24.

Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) investigators. Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomised trial. Lancet. 2006 Feb 18;367(9510):569-78. doi: 10.1016/S0140-6736(06)68147-6. PMID: 16488800.

Armstrong PW. A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention early after ST elevation myocardial infarction: The WEST (Which Early ST elevation myocardial infarction Therapy) study. Eur Heart J. 2006;27:1530–8.

Scheller B, Hennen B, Hammer B. Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction. J Am CollCardiol. 2003;42:634–41.

Fernandez-Aviles F, Alonso JJ, Castro-Beiras A. Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST segment elevation (GRACIA-1): A randomised controlled trial. Lancet. 2004;364:1045–53.

Andersen HR, Nielsen TT, Rasmussen K. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003;349:733–42.

Di Mario C, Dudek D, Piscione F. Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined AbciximabREteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI): An open, prospective, randomised, multicentre trial. Lancet. 2008;371:559–68.

Collet JP, Montalescot G, Le May M, Borentain M, Gershlick A. Percutaneous coronary intervention after fibrinolysis: A multiple meta-analyses approach according to the type of strategy. J Am CollCardiol. 2006;48:1326–35.

Keeley EC, Boura JA, Grines CL. Comparison of primary and facilitated percutaneous coronary interventions for ST elevation myocardial infarction: Quantitative review of randomised trials. Lancet. 2006;367:579–88.