Key result
Pharmacological thrombolysis succeeds in ~91% of remote STEMI patients, but failure links to high mortality.
Why the study?
STEMI is a time-sensitive cardiac emergency requiring prompt reperfusion therapy, but its management and outcomes in remote areas are underexplored.
Does pharmacological thrombolysis effectively achieve reperfusion in patients with STEMI presenting to remote, GP-led hospitals?
Does pharmacological thrombolysis effectively achieve reperfusion in patients with STEMI presenting to remote, GP-led hospitals?
Pharmacological thrombolysis for STEMI in remote, GP-led hospitals achieves high rates of successful reperfusion, though failure occurs in ~9% of patients and is strongly associated with alcohol consumption and anterolateral MI.
Answers are grounded in this paper and cite their sources.
Failed thrombolysis signals >20% mortality in remote STEMI; this Level 3 cohort leaves open predictors such as alcohol use and anterolateral MI.
Objectives: Acute ST-segment elevation myocardial infarction (STEMI) is a time-sensitive cardiac emergency requiring prompt reperfusion therapy. Management and outcomes in remote areas are underexplored. This study explored the STEMI reperfusion network in Al Wusta governorate in Oman and evaluated the effectiveness of pharmacological thrombolysis in general practitioner (GP)-led, resource-limited hospitals. Methods: This retrospective study reviewed administrative health registries and medical records of patients presenting with STEMI to hospitals in the Al Wusta governorate between June 2017 and December 2024. Response to thrombolysis was defined as 50% resolution of ST-segment on electrocardiogram. Outcomes post-thrombolysis were prespecified. Multivariate logistic regression was used to identify predictors of thrombolysis failure. Results: A total of 139 patients were included and received pharmacological thrombolysis, of whom 136 (97.8%) were male and the mean age was 47.8 ± 9.8 years. Thrombolysis failed in 13 patients (9.4%); all 3 deaths (2.2%) occurred in this subgroup, representing a mortality rate of over 20% among those with failed thrombolysis. Alcohol consumption and anterolateral myocardial infarction were strongly associated with failed thrombolysis, with odds ratios of 4,417.7 (95% confidence interval [CI]: 22.4–868,125.8) and 48.9 (95% CI: 2.0–1,156.8), respectively. The reperfusion network functioned effectively despite the absence of percutaneous coronary intervention centres and formal emergency medical services. Conclusion: While high rates of successful pharmacological reperfusion were achieved in GP-led hospitals, failed thrombolysis remains a significant concern. Targeted interventions at both patient and health system levels are necessary to improve outcomes. This study offers valuable insights for optimising STEMI care and guiding policy development in underserved regions.
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Harthi et al. (2026) studied this question. Pharmacological thrombolysis succeeded in 90.6% of STEMI patients in remote Oman hospitals, but failed thrombolysis had a mortality of >20%, linked to alcohol use and anterolateral MI.
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