Clinical and Angiographic Profile of Failed Thrombolysis in STEMI Patients

Background: Failed thrombolysis remains an important clinical problem in patients with ST-segment elevation myocardial infarction (STEMI), particularly where fibrinolysis is used as the initial reperfusion strategy. This study evaluated the clinical and coronary angiographic profile of patients with failed thrombolysis. Methods: This observational study included 196 consecutive patients with STEMI and failed thrombolysis who underwent coronary angiography during the index hospitalization. Failed thrombolysis was defined as <50% resolution of maximal baseline ST-segment elevation at 90 minutes after fibrinolytic therapy with persistent or recurrent ischemic chest pain. Demographic and clinical characteristics, cardiovascular risk factors, ischemic window period, fibrinolytic therapy, angiographic findings, revascularization strategy, and in-hospital mortality were assessed. Results: The mean age was 53.2 ± 11.8 years, and 158 (80.6%) patients were male. Smoking (45.4%) and diabetes mellitus (44.6%) were the most prevalent cardiovascular risk factors. The mean ischemic window period was 6.3 ± 2.3 hours. Streptokinase was the predominant fibrinolytic agent (91.8%). The left anterior descending artery was the most frequent infarct-related artery (53.6%), while single-vessel disease was present in 55.1% of patients. TIMI grade 0/1 flow was observed in 151 (77.0%) patients, whereas TIMI grade 3 flow was present in only 11 (5.6%). Rescue or subsequent PCI was performed in 166 (84.7%) patients. In-hospital mortality occurred in 7 (3.6%) patients. Conclusion: Failed thrombolysis was associated with a prolonged ischemic window and severe residual epicardial coronary obstruction. Most patients underwent rescue or subsequent PCI, with a relatively low in-hospital mortality. Early recognition of failed reperfusion and timely angiographic assessment with appropriate revascularization remain important in this setting.