Vol. 7, Issue 2, Part A (2025)

Introduction: ST Elevation Myocardial Infarction (STEMI) is one of the most fatal emergencies contributing to significant morbidity and mortality due to coronary artery disease. Reperfusion is the mainstay of management of STEMI and it is done in a time-dependent manner. Primary PCI is the gold standard management protocol which is scarcely available in developing countries. Thrombolytics like Streptokinase (SK) and Tenecteplase (TNK) by far remains the only option in such critical situation. Successful reperfusion therapy mainly depends upon time of presentation, type of agent used and underlying co-morbidities.
Aim: To compare the in hospital outcome in terms of efficacy & safety profile of streptokinase and Tenecteplase in patients admitted with acute ST Elevated Myocardial Infarction (STEMI) within a given time frame in terms of resolution of ST-segment elevation after 60 minutes of thrombolytic administration and to compare the in hospital complications and mortality during index hospitalization of therapy.
Methods: This is a prospective, single-center; observational study which was conducted in the Department of Cardiology of Jalalabad Ragib Rabeya Medical College Hospital, Sylhet from January 2024 to December 2024. About 100 patients were included and were divided into two groups (50 in each group) who are diagnosed as STEMI and who received either Streptokinase or Tenecteplase as thrombolytic agent. A reduction of ≥50% of the initial ST elevation was considered as successful thrombolysis. The efficacy of the thrombolysis with these agents were assessed based on the extent of ST segment resolution in Electrocardiogram (ECG) after 60 minutes of post thrombolytic administration and observing the complications and mortality during index hospitalized period.
Results: There was no statistically significant difference between the two groups with respect to ST segment resolution. After 60 minutes of thrombolysis, 82% of patients who received Streptokinase showed ST segment reduction and 86% patient who received Tenecteplase showed significant ST segment reduction, respectively. In hospital complications were similar in both the groups. Major bleeding was seen 3(6%) in Streptokinase group & 1 (2%) among group who received Tenecteplase. Hypotension was seen more among group receiving Streptokinase 10(20%) compared to Tenecteplase, 3 (6%), re-infarction was seen in 4 (8%) patient in Streptokinase group and 2 (4%) in Tenecteplase group respectively. In hospital death was also similar in both groups, 3(6%) in Streptokinase group and 2(4%) in Tenecteplase group respectively.
Conclusion: Streptokinase and Tenecteplase were found equally efficacious as thrombolytic agent in terms of ST segment resolution. Also both the agents were comparable in terms of in-hospital complications and mortality.