Impact of Failed Thrombolysis: Clinical Outcomes in a PCI-Capable Setting

Background: Streptokinase remains the primary mode of reperfusion therapy in many centers, including some with percutaneous coronary intervention (PCI) capabilities. According to the pharmacoinvasive strategy, all ST-elevation myocardial infarction (STEMI) patients who receive thrombolysis should undergo routine angiography, while those with failed thrombolysis must undergo urgent rescue PCI. However, the rate of complications following unsuccessful thrombolysis and the frequency of rescue PCI are not well studied in our setting. Objective: To determine the frequency of rescue PCI and compare the rates of in-hospital complications between successfully and unsuccessfully thrombolysed STEMI patients. Methodology: Patients receiving intravenous streptokinase for their first STEMI were enrolled 90 minutes post-infusion. Patients with cardiogenic shock, third-degree heart block, acute left ventricular failure, or left bundle branch block before thrombolysis, and those with contraindications to thrombolysis or who declined participation, were excluded. Patients were followed until discharge to assess the incidence of cardiogenic shock, left ventricular failure, left ventricular dysfunction, acute kidney injury, and in-hospital death. Outcomes were compared between patients with successful versus unsuccessful thrombolysis. The frequency of rescue PCI was also recorded. Results: A total of 391 patients were included, with males comprising 75% of the sample. The most prevalent comorbidities were diabetes (54%) and hypertension (32%). Anterior and inferior wall STEMI each accounted for 36% of cases. Thrombolysis was successful in 73% and unsuccessful in 27% of patients. Mortality was 7.3% in successfully thrombolysed patients and 14% in the unsuccessful group. All pre-specified complications were significantly more common in the failed thrombolysis group. Only 19% of patients underwent rescue PCI. Conclusion: Streptokinase-based thrombolysis results in suboptimal reperfusion in a significant proportion of STEMI patients. Furthermore, the rate of rescue PCI among these high-risk individuals remains low. There is a critical need to enhance reperfusion strategies in PCI-capable settings.